or most clinicians, the stack of journals that rapidly accumulates and waits to be read is a constant reminder of the steady growth in medical knowledge. The sheer volume and complexity of expanding medical knowledge demands the increased use of electronic systems to organize and retrieve information when it is needed. In an attempt to increase access and meet the perceived needs of physicians, electronic systems designers have developed a variety of technologies for delivering information to clinicians. Textbooks on CD-ROM, educational Web sites, online journals and even simulators and automated record keeping systems all have the capability to deliver information that is much more dynamic and accessible to the anesthesiologist than paper. The very nature of this technology offers the capability of interactivity, multimedia presentation and dynamic response. Despite an explosion in medical electronic educational systems in the past decade, physicians have been inconsistent in adopting these systems.

To fully integrate information delivery systems into clinical practice, a fundamental step is to design a user interface that will meet the specific needs and behaviors of physicians at the bedside. Knowledge of physician information-seeking behavior (a basis of library science) has been instrumental in guiding the design of dynamic, accessible tools at the point of care.

In the 1960s, the Boeing Corporation undertook one of its first analyses of information-seeking behavior in an attempt to improve the flow of technology and communication within their division of research and development.¹ In this benchmark study of senior scientists, two groups with distinct information needs were identified: scientists and engineers. The scientists were characterized as those who transformed verbal information into the industry’s scientific literature (verbal to verbal), whereas engineers encoded this verbal information into product development. That is, within this same scientific community, individuals were sociologically organized according to their goals, and more importantly, their information-seeking behavior within the group reflected these different goals. This observation of complex information-seeking behavior initiated a new approach to the design of information presentation and organization technology.

This classic model based upon the work at Boeing can be applied to medical professionals. The information needs and preferences of physician scientists and clinicians closely parallel those described for scientists and engineers. Physician scientists, like industrial scientists, seek verbal information in their production of scientific papers. Clinicians, on the other hand, seek information to formulate processes such as treatment plans, differential diagnoses and technical procedures. Furthermore, information needs are often confounded by the fact that physicians assume multiple overlapping roles in their work environment. It has, therefore, been challenging to design usable information systems that meet the needs and preferences of most physicians.^2,3

When seeking complex answers, physicians, for several reasons, are known to consult colleagues rather than head to the library. Certainly time and location are critical factors — accessibility and availability of information are known to be more important than accuracy. Also organization of information in text-based resources (single-topic chapters or journal articles) does not necessarily supply answers for individual patients whose treatment often overlaps into several organ systems.

Physician information needs have been defined by Gorman into four subtypes.² Recognized needs are clearly articulated by the searcher and are undeniably a part of routine medical practice. Unrecognized needs for information motivate browser behavior in electronic resources where the searcher may realize that he or she needs additional information on a topic but may not be certain exactly what type of information is needed. Other well-described types of physician-specific information needs include pursued needs identified by the actual observation of information-seeking behavior and satisfied needs that are recalled as information-seeking successes.² All of these behaviors and needs must be satisfied by a successful electronic education system.

Anesthesiologists form a unique subgroup among physicians in that our patient care always takes place within an operating room environment that precludes any possibility of consulting personal or public libraries when a need for information arises at the bedside. Low-frequency events (such as the unexpected difficult airway) carry high morbidity and demand that we follow algorithms not easily committed to memory but which are needed in a critical time period (“just in time”). Technical procedures (such as regional blockade) are usually practiced on live patients (point of care). The need for accessibility of critical information just in time and at the point of care is a hallmark for defining future electronic education systems for clinical anesthesiologists.

Electronic educational systems in anesthesiology should not be limited to the operating suite. In fact classic resident education may be the area where electronic educational systems are developing most rapidly. Likewise patients have learned to use the accessibility and immediacy of the Web to obtain information about topics such as anesthetic care, which was not readily available prior to the Internet. Finally, although the Internet was initially developed as a tool for communication of research scientists, the use of electronic educational systems in research have expanded to include the larger medical community. Biomed Central provides open-access journals in multiple specialties allowing for instant and public review of new science. Started by Harold Varmus, M.D., Nobel Laureate and former Director of the National Institutes of Health (NIH), Biomed Central has become the model for open-source publication.

Electronic educational systems differ from other information technology (IT) systems in the content delivered. The content must suit both pursued needs and browsing needs. The content credibility also must be embedded in the system, including author and publisher credentials. Unfortunately academic credit is not uniformly given for writing educational content that appears in electronic resources versus content that appears in paper-based textbooks (chapters, reviews, etc.). Reasons given for this discrepancy include a perceived lack in editorial supervision and peer review as well as inability to archive. These hurdles are gradually being addressed, and many academic institutions now include electronic authorship in determining advancement in clinical educator tracks.

Many pioneers are currently developing Web-based electronic educational systems that meet the needs and behaviors of the group for which they are designed. Although many excellent systems exist in other formats, the Internet in particular allows open access and is easily incorporated into hospital IT systems. Examples of some of these sites are listed in Table 1.

The future of electronic educational systems for physicians depends upon a willingness to incorporate these systems into tools and environments that address the behaviors and needs of the users. For the anesthesiology community, the academic and corporate worlds will need to develop new partnerships to embed educational programs into current operating room systems to ensure availability, accessibility and reliability of information resources.

References:

1. Allen TJ. Managing the flow of technology: Technology transfer and the dissemination of technological information within the R&D organization. Cambridge, MA: The MIT Press; 1977.

2. Gorman PN. Information needs of physicians. J Am Soc Inf Sci. 1995; 46:729-736.

3. Leckie GJ, Pettigrew KE, Sylvain C. Modeling the information-seeking of professionals: A general model derived from research on engineers, health care professionals and lawyers. Library Quarterly. 1996; 66:161-193.


Disclosure: The author is Senior Editor of GASNet,™ the Global Anesthesiology Server Network.

Charlotte Bell, M.D., is Professor and Director of Pediatric Anesthesiology, New York University School of Medicine, New York, New York. She is President-Elect of the Society for Technology in Anesthesia.