Locations at which the physicians access information

In general, the paediatricians’ access to information towards the discharge of their patient care roles and professional development was done at three locations; at the workplace, at home, and other locations outside their hospital. This is shown in figure 34.

61 _{Interview 10} 62

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Figure 34: Points at which the physicians accessed information

Information access at the workplace

The physicians revealed in majority of the interviews that people engaged in the practice of accessing information while at work. This practice occurred at several points within the hospital; access in the doctors’ call room, access during ward rounds, access during clinical meetings, conferences and seminars, and access during patient consultations and treatment.

Access during clinical meetings, conferences and seminars

During clinical meetings, conferences and seminars, people exchanged ideas and generally share knowledge among themselves. Comments revealed that these activities were held very often during the weekdays, Monday to Friday. One interviewee described what usually happens at those meetings:

“[…] every Monday morning there will be clinical meetings to review difficult cases. At that moment, we are exchanging information and learning. On Tuesdays we have what is called postgraduate seminars where somebody presents what he or she has researched on. This is also an avenue for learning. On Wednesdays, units present an analysis of the difficult cases they managed and how they applied the standard or newer modalities concerning that case. I think that every day we have a way of acquiring knowledge […]”.

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This discussion forum which according to this clinician, ‘happens regularly’ was also in her view, able to offer opportunity for the physicians to ‘learn’ and to ‘keep up to date’63.

Access during patient consultation and treatment

Many interviewees agreed that seeking for information at the point of patient evaluation or treatment happened regularly among the physicians. Obtaining information in this way was said to take place through means such as brief discussion with a colleague, a quick browse through books, computers and other i-media (smart phones, iPads), and phone calls to other physicians. Some clinicians made statements that mirrored this type of information practice. Key words in the comments are deliberately highlighted to show the context of information access during patient consultation:

“[…] but when I discussed with my colleague who was with me right there in the clinic, there were other things we found out”. (Interview 2, Resident, male).

“Even at the point of care one can source for information. Nobody knows it all. Your memory mail fail at that moment to remember what you learnt back in the medical school days, so you need a place where you can easily check-up information. You may even have your books around or your computers or tablets around to check-up whatever you think is not too clear about a patient”. (Interview 10, Resident, female).

“I am always consulting with my iPad by my side because it gives me quick information whenever I need to do a check on anything” (Interview 12, Registrar, female).

“We had in the last few days a baby that came in the new born unit and was suffering from one rare condition that we had always read about but had not handled before. My colleagues used their phones to start searching on what to do on the type of prescriptions and treatment to be given”. (Interview 14, Consultant, male).

Access during ward round

Participating in the ward rounds afforded the paediatricians another opportunity to access information relevant for building their knowledge. The main sources of information during the ward rounds were the Consultants, discussions among team members, and the use of i- media sources for quick search.

Specifically, the ward rounds were used as training programmes for the junior physicians, and during that time, the consultants usually passed on useful knowledge to those in their teams. This information activity was attested to by this clinician who said that ‘the consultants

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educate us the younger doctors during the ward rounds’64 and another who learnt about information sources during a ward round:

[…] during the rounds with the consultants they told us the sources that could be helpful so like that we picked up on the beneficial information sources”. (Interview 13, Resident,

Female)

Ward rounds provided a forum for team members to engage in discussions, knowledge sharing and other collaborative information activities as was attested to by these comments from some clinicians:

“I remember a time during ward round there was an issue and one of us instantly browsed on his phone and got the information we needed which helped us in treating that patient”. (Interview 14, Consultant, male).

“[…] if you have information you will pass it on to your colleagues during ward round and we discuss […]”. (Interview 19, Consultant, male).

“[…] during some ward rounds, some patients can present with bizarre presentations; something that is not specific. Even at the bedside, you can google or browse for more information or search to refresh yourself on something you have read before but have forgotten the typical presentation”. (Interview 5, Resident, Male).

Access in the Doctors’ Call Room and Lounge

As obtainable in many other departments of the hospital, Doctors’ Call Rooms were provided at the different units of the paediatric department for intermittent rest and for securing

personal effects, when the physicians were on duty65. This location served as a point where people engaged in information search, particularly when faced with an immediate challenge during patient care, such as described by this physician:

“When you are seeing it [an ailment] face to face, even what you’ve learnt might look obscured and not be too vivid anymore, so I used to go back to the call room to brush up my knowledge with my computer or my books”. (Interview 10, Resident, female).

The researcher observed that the call rooms had television sets with satellite connection that provided news and entertainment from an array of stations. One clinician believed that some of the television programmes on some sparse occasions provided him with useful medical information66.

64 _{Interview 9}

65 _{Some of the researcher’s interviews with the physicians were conducted at the call rooms at the three units of}

the hospital’s paediatric department, affording him opportunity to observe first-hand how people used this venue for information search while on duty.

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Similarly a doctors’ lounge exist at the hospital-wide level where physicians meet to unwind from stress, have dinner and generally interact among themselves67. One resident’s view about the lounge on information sharing is that:

“It is always important to visit the doctors’ lounge where ideas are shared. Sometimes one can pick up solution to a problem one had encountered in the course of the discussions or a new treatment procedure from people who have attended conferences and workshops elsewhere” (Interview 17, Resident, male)

The paediatricians perceived the discussions in the lounge as an avenue for obtaining useful medical information from colleagues in the different departments of the hospital. Information access at home

There was a general consent among the physicians that one of their information practices was engaging in information search activities while at home and off patient care duties. One significant reason given for this practice was because of the absence of immediate pressure from patient care duties at home. This Consultant made reference to that factor with these statements:

“[…] my laptop and internet access helped me to access the information that I needed. But you know at that point in time I could not do that and I had to go home to be able to do that and come the next day to use the information I got. I provided access for myself and I couldn’t do it in the hospital. I needed to go home and do it […]”.

“I have bodies I belong to that send me updates on new researches and other information that I receive on my smart phone and then check on them more thoroughly when I get home”. (Interview 15, female and Consultant).

Another reason that necessitated this Consultant’s preference for conducting information searches at home was her perception of the hospital library as not offering any form of

advantage. She said; ‘I have not seen any added advantage going there [the library] to access information that I cannot easily access in my house’.

This tends to echo the sentiments of many others who would rather not use the hospital library. A Resident physician also muted the notion of freer time as encouraging people’s information search at home:

67 _{During a particular visit to collect a participant’s Diary in January 2016, the researcher was invited by a}

Resident to the doctors’ lounge. That invitation afforded the researcher the privilege of observing physicians from different departments of the hospital discussing about diverse issues in a relaxed atmosphere. Most of the topics they discussed were related to patient care and some challenges they encountered. Sometimes there were

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“After the normal treatment and contacts for the day, for those in the wards, you go back home and do more research […]” (Interview 2, Resident, male).

In situations where the physicians encountered a serious challenge that needed to be researched on during patient care, most times people were asked to do so individually at a later time. What people usually did in those circumstances is mirrored by this case:

“So, we were trying to clarify and everybody was asked to go and read about these conditions to verify the typical presentations in a child. So people went home and checked up textbooks and the Web, came back and discussed and arrived on something.” (Interview 5, Resident, Male)

Information access at other external locations

Physicians accessed information relevant to patient care at locations outside of the hospital such as when they attended externally organised conferences, seminars and workshops. The hospital provided limited sponsorships for the physicians to some of these external

conferences hence affording people the opportunity of engaging in knowledge sharing with colleagues from elsewhere. As some clinicians said:

“The hospital sponsors people once in a while for update courses where we meet other colleagues and lecturers who teach on specific courses […]”. (Interview 10, Resident,

female).

“When we attend [those] conferences and workshops we get a lot of information, especially conferences that are tailored towards sub-specialties, you get information about your own sub-specialty […]”. (Interview 15, Consultant, female).

Discussing about some of the information literacy trainings available during her residency programme, a Senior Registrar described how locations external to the hospital afforded people opportunity for information access. She said:

“During residency I attended conferences and seminars where we were taught how to do research and how to conduct information searches. We were taught research methodology and how to use the internet for information search. We were introduced to the use of PubMed for obtaining medical information” (Interview 11, Senior Registrar,

female).

There was a widely acknowledged view among the clinicians that people were very open to the practice of sharing the knowledge obtained from those external locations and sources with their colleagues, on return to the hospital.

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