Integrating personal computers into family practice: a comparison of practicing physicians and residents*t

comparison

of

practicing physicians

and

residents*t

By Martha C. Cook,M.L.S., AHIPt

Technical Services/Systems Librarian

Health Sciences Library Julia A. Hartman, M.A. Research Associate

DepartmentofBehavioral andCommunityMedicine Lisa Rains Russell, M.L.S., AHIP

ChiefMedical Librarian Health Sciences Library

UniversityofAlabama School ofMedicine Tuscaloosa Program

Box 870378

Tuscaloosa, Alabama 35487-0378

A survey wasused to assess levels of experience with personal

computers and interestin learning personalcomputer applications

among Alabama family practice

physicians

and residents in 1994. The study compared responsesof 272

physicians

and 77 residents aswell as

responses of

physicians

and residents in asample of respondents

thirty-eight

years old or younger, including 77

physicians

and 73 residents. Almost 25% of

physicians

reported never

having

used acomputer,

compared to 7.9% ofresidents. Respondents

had

learned computer skills

through

variouscombinations of

methods,

with

over

half

ofeach

group claimingtobe

self-taught

through

reading and

hands-on

experience. More than 86% of

both

groups expressed interest in

learning more; interest increased inthe population

thirty-eight

years or younger. Respondents, especially

physicians,

reported using

professional applications lessoften than personal applications. Overall, there was a

high

level ofinterestin learningvarious practice-related applications;

however,

a significantly largerproportion of residents

reported interest in

each

type ofapplication

than

did

physicians.

INTRODUCTION

The

impetus for

this

study was the perceived lack of

interest in computer use, poor attendance at training sessions, and low Grateful Med usage among practic-ing

physicians

in Alabama. A survey was conducted

*Thisarticle is based in part onapaperpresented atthe 46th

An-nualMeetingoftheSouthernChapter/MedicalLibraryAssociation,

Memphis, Tennessee, October 13, 1996.

tThis researchwassupported byagrant fromtheCollegeof Com-munity Health Sciences Research Committee, University of Ala-bama.

tPlease sendall correspondence toMarthaC. Cook,HealthSciences

Library,University ofAlabama, Box870378,Tuscaloosa, AL 35487-0378. Phone: (205) 348-1366. Fax: (205) 348-9563. E-mail:

[email protected].

in1994 to assess

the

useof personal computers among a group of practicing

physicians

and a group of resi-dents. Bothgroups were in the family practice area.

BACKGROUND

The information needs of physicians have been

cate-gorizedasrelated toclinicalpractice, continuing med-icaleducation, or research[1].

Although

computerized

retrieval of information was already an option inthe

early 1990s, studies showed that physicians rarely used computers to answer case-specific clinical

ques-tions

[2-4].

AccordingtoFox,family

physicians,

whose

information needsshouldbegreaterthanthoseof spe-cialists because ofthedepthandbreadthoftheir

prac-tices, were not utilizing computer

technology

to meet

these

needs [5].

McCarthy

described computer use among physicians as "established and growing," but notedthatmeasures may indicate potentialratherthan

actual use and that nonprofessional computer activi-ties may represent a substantial proportion of use among physicians who own personal computers [6].

The failure to integrate computer applications into

undergraduate, graduate, and postgraduate curricula,

as well as into clinical settings,

has

also been studied [7]. Review of

the

literature related to computer

tech-nology in undergraduate medical curricula reveals varyingdegrees ofinterestand action in incorporating

such

training.

By 1986 only a few medical

schools had

followed

the recommendation ofthe 1984 Panel onthe General

Professional Education ofthe

Physician that

informa-tion science and computer

technology

be integrated into the professional education of physicians [8]. In 1989Barnett reportedthatmedical educators were fall-ing

short

in

teaching their

students

how

toutilize per-sonal computers in

the

practice of medicine [9]. As recognition of

the

value of information

technology

in medical education became more widespread, some medical

schools

began to incorporate a variety of

ap-plications into

their

curricula: access to

the

knowledge base, computer-based simulations, computer-assisted

instruction, medical informatics applications, patient

information systems, computerized medical records,

and electronic mail andbulletin boards [10].

Haynes et al. supported

the

theory

that

computer applications that are integrated into clinical practice are more effective than computer-aided instruction

presentedin alaboratory setting.

They

stated

that

"ex-posing students to computer applications in

the

set-tings inwhich

they

can improve clinical effectiveness

and

efficiency

... willbelikelytogivestudentsall

the

impetus

they

require tobecome knowledgeable about

these

new tools"

[11].

Whatever the

approach,

the

As-sociation of American Medical Colleges noted that

medical students need a strong foundation in

com-puter

technology

to meet

their

needs in information

management, patient care decision-making, and

de-velopment as lifelong learners

[12].

Residency training curriculaalso oftenfailed to ad-dress computer education. More

than

ten years ago, Manning noted

that

computers would "undoubtedly

make practice-based continuing medical education

more efficient" [13]. At that time many computer

ap-plications were already available for

research,

diag-nosis, communication, clinical management, and med-ical education, but physicians lacked the computer

knowledgetoutilizethem effectively.Robie notedthat

acomputer curriculum component inresidency

train-ing was uncommon and suggested that advances in

computerhardware andsoftware signaled thatit was time to extend computer

teaching

intohousestaff

ed-ucation [14]. A lack of formal computer education in

medical

school

and residency programs despite ade-quate access for both residents and faculty was noted by Debehnke and Valley [15]. In 1995 Rowe et al.

re-portedthatmostresidents

they

surveyed feltthat com-puter instruction "shouldbe a mandatory component offamilymedicine training programs" and that assis-tance inthe form of time and funding shouldbe pro-vided to aid in the process. The residents expressed interest in learning word processing, database

search-ing, officebilling, and office management software,

al-though many were already using a variety of com-puterapplications (includingword processing, games, educational applications, spreadsheets, graphics, and

database

searching)

in spite of

the

lack of formal in-struction [16].

METHODS

The present study was developed to assess the levels

of experience with personal computers (PCs) and in-terest in learningPC applications among family prac-tice

physicians

and residents in Alabama. In Novem-ber 1994, a 48-item survey (AppendixA) was mailed to all 627membersoftheAlabama Academy of Family

Physicians;

a stamped return envelope was provided. Items on

the

survey addressed personal and practice

demographics

and computer experience, access, and attitudes. A totalof272

physicians

returned

the

survey

for a responserateof 44.7%. Asimilar 37-item survey

(Appendix B) was distributed by residency program staff to the 144 residents in the sevenfamily practice

residency programs inAlabama. Of

these,

77residents

returned the survey for aresponse rate of 53.8%. RESULTS

In

the

discussion of

the

results of

this

study,the term

"physicians"

is used to refer to practicing

physicians

as

they

are compared to residents. The term "resi-dents" refers to respondents from one of

the

seven

family practice residencies in Alabama. Of the

physi-cians responding, 87.3% (n = 233) were male and

12.7% (n = 34)werefemale; these figureswere72.7% (n = 56) and27.3% (n = 21), respectively, forthe res-idents

who

responded. Witha meanage of 45.9 years

(SD = 10.8),

physicians

were significantly older than the residents (mean = 30.1 years, SD = 4.9; t = 18.28,

df= 280.54, P < 0.001). This difference in mean age

prompted

the

datatobe analyzed in twoways. In ad-dition to comparing the responses of all residents to

thoseof allthe

physicians,

responses of residents and

physicians

werealsocomparedin asample comprised

ofonly those respondents 38years of age oryounger.

The age of 38 was selected as a cutoff because the

re-sultinggroups of residents and

physicians,

referredto asthe"younger" group,wereapproximately the same

Table 1

Locationsof personal computer use

Overall Younger

Physicians Residents Physicians Residents (n =265) (n =76) (n=76) (n =72)

%(n) %(n) %(n) %(n)

Neverused PC 23.8(63) 7.9(6)** 17.1 (13) 8.3(6) Usedathome 48.5(132) 62.3(48)* 54.5(42) 60.3(44)

Used atcollege 10.3(28) 46.8(36)** 19.5(15) 47.9(35)*

Usedatmedical school 9.6(26) 53.2(41)** 13.0(10) 54.8(40)**

Used in residency 12.9(35) 46.8(36)** 26.0(20) 49.3(36)* P <0.05.

P<0.005.

size (n = 73 and n = 77, respectively).

Although

the

mean age of the

physicians

in

the

younger group (mean = 34.9years, SD = 2.5) was significantly

higher

than that of theyoungerresidents (mean = 29.1years, SD = 2.7;t= 13.56,

df

= 148, P<0.001), thevariances were not significantly different.

As

shown

inTable 1, almost

one-fourth

of the

phy-sicians reportednever

having

usedaPC, comparedto asignificantly lowerpercentage (7.9%) of residents.In

the

younger group,

these

figureswere17.1%and8.3%, respectively, and the difference was not significant. Significantly larger proportions of residents reported

having

used a PC incollege, medical

school,

and

res-idency

than

did

the

physicians

overallor

the

younger

physicians.

Almosthalf of all residents

had

used a PC atcollege; exactly the same percentage had used one

during residency; and

slightly

more than

half had

usedaPCduring medical

school,

ascomparedtoonly 10-13% of all

physicians

and 13-26% ofyounger

phy-siciansduringany of

the three. When

compared toall

physicians

asignificantly larger proportion (62.3% vs.

48.5%) of the residents had used a PC at

home,

but among

the

younger

physicians,

the difference was

muchsmaller(54.5%of

physicians,

60.3% of residents).

Residents were significantlymore likely tohave

ac-quired some abilityto use a PC thanwere

physicians

overall

(X2

= 6.82,df= 1, P < 0.01), butthe difference

intheyounger group was notsignificant. Whenasked toassesstheirPCskills, 17.1%(n = 13)oftheresidents and 32.6% (n = 85) of

the

physicians

said

they

could

do no more than turn on a PC; these figures were 17.8% (n= 13) and 26.3% (n = 20) amongtheyounger residents and physicians, respectively. More than half (61.8%, n = 47 overall; 61.6%, n = 45 younger) ofthe

residentsindicatedthat theycould run programsfrom menus or by using a mouse, and anadditional 21% (n

= 16overall,n= 15younger) indicatedthattheycould

accomplish more complex tasks. Among the

physi-cians, 37.2% (n = 97) overall and 42.1% (n = 32) of

the younger said they could handle the basic skills,

while 30.3% (n = 79) overall and 31.6% (n = 24) of

the younger could also complete the more difficult

tasks.

Overall almost

half

(48.9%, n = 129) of

the

physi-cians reportedusingaPCatleast onceaweek; overall

the

remainder was split relatively equally between

those

never using a PC (24.2%, n = 64) and

those

whose

use was less frequent

than

weekly (26.9%, n =

71).

Slightly

feweroftheyounger

physicians

(46.8%,n

= 36) reported weeklyor more frequentuse;36.4%(n

= 28)reported lessfrequentuse, and only 16.9% (n =

13) reported never using a PC.

Both

of

these

distri-butions were significantly different from

the

frequency of use among the residents

(X2

= 48.7, df = 2, P <

0.001 overall;

X2

= 15.67, df= 2, P < 0.0005younger). The overwhelming majority (70.1%, n = 54 overall; 68.5%, n= 50younger)of residentsreportedlessthan weeklyuse, andrelativelyfew (n = 5)for

both

group-ingsreportedneverusing aPC;approximatelya quar-ter (24.7%, n = 18

both

groups) reported using a PC at least once a week.

The

residentsand

physicians

respondingto

the

sur-veyhad learned computer skills

through

various com-binationsof

methods.

Overhalf of

both

groups(54.5%,

n = 42 of residents and 56.3%, n = 153 ofall

physi-cians) reported

teaching

themselves

through

reading

and

hands-on

experience; 63.6% (n = 49)of

the

youn-ger

physicians

and 54.8% (n = 40)oftheyounger res-idents had learned computer skills on their own. In-formal instruction from friends or colleagues was a source of learning for 45% of

the

residents (n = 35

overall,n = 33younger),and for 33.5% (n = 91)ofall

physicians

and 36.4% (n = 28) of

the

younger ones.

Overall, a significantlygreaterproportion of residents had taken computer classes in

high school

or college

than

had

physicians

(20.8%, n = 16 and5.1%, n = 14,

respectively;

X2

= 18.76, df = 1, P < 0.001), but

there

was nosignificantdifferencewhen

the

younger groups

werecompared (14.3%, n = 11

physicians;

20.5%, n = 15 residents).

An interest in learning more about PCs was

ex-pressed by 87.0% (n = 228) of

the physicians

and

88.2% (n = 67) of the residents.

These

figures in-creased to89.3% (n = 67)and 90.3% (n = 65),

respec-tively, when only the youngerrespondents were

com-pared. Well over

three-fourths

(84.1%, n = 286) of all

respondents expressed an interest in workshops or courses tohelp themintegrate PCs intotheirpractices;

this included 89.8% (n = 132) of the younger group. The proportion of all residents who indicated no in-terest (5.3%, n = 4)wassignificantlysmallerthan that

of all

physicians

(18.9%, n = 50,

X2

= 8.01, df = 1, P

< 0.005), butthedifference was not significant among intheyounger group (5.6%, n = 4 residents; 14.5%, n

= 11 physicians).

Both similarities and significant differences were found between residents and physicians when

Table 2

Computer application use

Overall Younger

Physicians(n =272) Residents(n =77) Physicians (n= 77) Residents (n=73)

% (n) %(n) %(n) %(n)

Personal use

Any personal application 64.7(176) 79.2 (61)* 68.8 (53) 79.5(58)

Finances 34.6 (94) 16.9 (13)** 37.7 (29) 15.1 (11)** E-communication 25.7(70) 7.8 (6)** 24.7(19) 6.8 (5)** Investments 15.4 (42) 2.6 (2)** 16.9 (13) 2.7(2)** Workprocessing 51.1 (139) 61.0 (47) 53.2 (41) 61.6(45) Scheduling 15.1 (41) 16.9 (13) 16.9 (13) 17.8(13) Information management 27.6 (75) 20.8 (16) 31.2 (24) 20.5(15) Personal education 36.8 (100) 37.7 (29) 35.1 (27) 37.0(27) Games 43.0(117) 46.8(36) 48.1 (37) 47.9(35) Professional use

Any professional application 36.4 (99) 58.4 (45)** 39.0 (30) 58.9(43)*

Information mgmt./research 12.1(33) 28.6 (22)** 10.4 (8) 30.1 (22)** Database access 16.5(45) 28.6(22)* 13.0 (10) 30.1 (22)* Expert programs 12.1(33) 3.9(3)* 13.0 (10) 4.1(3)* Clinical practice mgmt. 11.0(30) 11.7(9) 11.7(9) 11.0 (8) Patienteducation 10.7 (29) 10.4 (8) 11.7 (9) 11.0 (8) CME 15.8(43) 7.8(6) 11.7(9) 6.8(5) E-communication 14.3(39) 6.5(5) 15.6 (12) 5.5 (4)* P<0.05. P<0.005.

shown

inTable 2,79.2%ofresidents and64.7%of

phy-sicians reportedusing a PC for personal applications. Word processing applicationswere used most

widely

by

both

groupsand over40% of

both

groupsused

the

PC for games. UseofPCs for personal education was

reported byapproximately 35% of

both

groups. Over-all and in the younger groups, a

significantly

greater proportion of

physicians

than of residents used

appli-cations for personal finances, electronic communica-tion, and personal investments.

Respondents, especially

physicians,

reported using

professional applications less often

than

personal

ap-plications; only 36.4%(n= 99)of

al physicians

(39.0%,

n = 30 of younger) and 58.4% (n = 45) of residents

(58.9%, n = 43 of younger) reported using any

pro-fessional application. Less

than

20% of

physicians

re-ported using any

specific

type of

professional

appli-cation. The 28.6%

each

of residents who

reported

use

of applications for information management or

re-search

and for database applications was

significantly

larger than that of

physicians,

but no

other

specific application was

reported

by more

than

12% of resi-dents. Significantly larger proportions of

physicians

than ofresidentsreportedusing expertdiagnostic pro-grams and electronic communication among younger

physicians.

Overall,therewas a

high

level ofinterest inlearning

avariety ofpractice-related applications,ranging from

a low of 70.7% (n = 222) respondents interested in

learning information management applications to a

high of 89.2% (n = 280) respondents interested in

learning patient managementapplications. However,a

significantlylarger proportion of residents reported an interest in

each

type of application than did

physi-cians, as represented in Table 3.

Learning

communi-cations applications was

the

lowest interest level among

the

residents, with 75.3% expressing an inter-est. In contrast, the

highest

level of interest reported

by

the

physicians

was 76.8% in patient management applications. In the younger groups, the proportions expressing an interest were

higher

in every category,

especiallyamong the

physicians.

DISCUSSION

Physicians'

recognition of the value of technology in

the

delivery of quality

health

careisevidencedby

their

use of

state-of-the-art

equipment for diagnosis and treatment, but manyfail to take advantageof

the

ben-efits of computer

technology

available to themfor pa-tientmanagement, expert consultation, patient educa-tion, information management and

research,

and con-tinuing medical education. Our study shows a

high

level of interest in developing computer knowledge among residents,

who

not onlyhave had more expo-sure tocomputers, but

who

arealso at apointintheir

medical training where

they

see so many needs and have so little time. Residency programs could provide

the opportunity to help physicians learn how to use computer

technology

to cope with the demands of a

medical practice.

Computer literacycurriculasuchasthatatBowman

Gray School of

Medicine,

Wake Forest University, are agood starting point.Thisprogramoffers threelevels

Table 3

Interest in learning personalcomputerapplications

Overall Younger

Physicians (n = 272) Residents(n = 77) Physicians (n = 77) Residents(n =73)

% (n) % (n) % (n) % (n) Business 73.2(199) 92.2(71)** 76.6(59) 94.5(69)' Patient management 76.8(209) 92.2(71)** 87.0(67) 94.5(69) Patient education 57.0(155) 90.9(70)** 71.4(55) 93.2(68)" CME 75.7(206) 90.9(70)** 88.3(68) 91.8(67) Expert consultation 69.1 (188) 85.7(66)** 79.2(61) 89.0(65) Bibliographicinfo./databases 65.8(179) 87.0(67)** 71.4(55) 87.7(64)' Communication 62.5(170) 75.3(58)* 68.8(53) 76.7(56) Information management 59.9(163) 76.6(59)* 68.8(53) 79.5(58) P<0.05. P<0.005.

ofinstruction,based ontheresidents' experiencewhen

entering the program. The first level introduces basic computer concepts,

hardware,

and operating systems;

the

second level includes instruction inword process-ing,

bibliographic

retrieval,and useofdruginteraction

software; andthe

third

levelfocusesondifferential di-agnosis programs. Residentsmayenterthecurriculum at the level appropriate for

their

own degree of com-puter

sophistication

[17].

In addition to

these

computer applications, a com-puter literacy curriculum in a residency program could also include electronic mail, computerized med-ical records, computerized

history-taking,

patient ed-ucation, practice management, expert systems, and continuing medical education. Integrating computer instruction into

the

medical training program would increase the residents' comfort level with computers and provide a practical setting in which to learn

ap-plications

through

hands-onexperience. CONCLUSIONS

Computers certainly will notreplace

physicians

in

the

foreseeable future, but

they

have greatpotential value in terms of increased efficiency, productivity, and

the

informed practice of medicine.

They

can serve as an invaluable link to libraries, colleagues, consultants,

bibliographic

databases,patienteducationinformation,

and Internetresources-especially for rural

physicians

and others practicingin isolated locations.

As

John

D. Rootenberg of Tulane UniversitySchool

of Medicine writes, "Likethe

stethoscope,

the scalpel, and thetextbook, the computer is a toolthatbecomes effective inthehandsof skilled users.Rather thanfault ourselves fortheinability to overcome our limitations, we should take advantage of the help computers can

provide"

[18]. A component of the residency curricu-lum focusing on the use oftechnology as it relates to patient and practice management, todiagnosis and

re-search,

and to the development of lifelong learning

skills is vital to a well-rounded program, and our

studyindicates that suchacomponent would be well-received byresidents.

Barry Weiss, M.D.,editorofFamily Medicine, sums it up well:

Ifwe are toeffectivelyprepare our traineesforthemedicine

they will practice inthe future, wemust stop focusingour

teaching efforts ontoday's (or tomorrow's)medicalsystem.

Instead, we mustconsiderthespanofourstudents' and

res-idents'futurecareersand anticipatethetoolstheywill need

to workin those careers. Weshould introduce our trainees to cutting edge technologies, even ifthose technologies are notyetfully developed.

Then

Weiss takes it one step

further

by adding

that

"family medicine academicians are not taking advan-tage of

the

leadership

role

they

couldplayin

the

com-puter revolution that will ultimately change primary care medicine" [19].

With

each

new class of residents changes in

their

attitudes toward computers and increases in

their

lev-els of computer knowledge have been noticed. There

is more interest, more expertise, and moredemand for computer literacy training and for computerfacilities. Arepeatof

this

studywouldlikely produce

somewhat

different

results-higher

levels of competency among residents and greater expectations for a computer ed-ucation component within the residency program. Computer literacy among the practicing physicians

will, of course, increase more slowly, but willdefinitely increase as the new generation ofphysicians replaces

theold. REFERENCES

1. ELYJW, BURCHRJ VINSONDC.Theinformation needs of

familyphysicians:case-specificclinicalquestions. J Fam Pract

1992Sept;35(3):265-69.

2. IBID.,266.

resource preferences of family physicians. J Fam Pract 1990 Mar;30(3):353-59.

4. VINCENT C, SCHNEEWEIss R. How family physicians

choose an office computer system. J Am Board Fam Pract 1992 May-June;5(3):275-80.

5. Fox GN. Computerliterature searching-will docs byte? Fam Pract ResJ 1991 Mar;11(1):9-13.

6. MCCARTHY JT.Estimatingthe number ofphysiciansusing computers[Letter].MD Comput1993Feb;10(2):74-77.

7. MULLERS, Chairman.Physiciansfor thetwenty-first

cen-tury: reportoftheProjectPanelontheGeneral Professional EducationofthePhysicianandCollegePreparationfor

Med-icine.J Med Educ 1984 Nov;59(11),Part 2:1-208.

8. BRESNITZ EA, STETTIN GD, GABRIELSON IW A survey of

computerliteracyamongmedical students.J Med Educ 1986 May;61(5):410-12.

9. BARNETT 0. Information technology and undergraduate medical education. Acad Med 1989 Apr;64(4):187-90. 10. JENNETTPA, EDWORTHYSM,ROSENALTW,MAES WRET AL. Preparing doctors for tomorrow: information

manage-ment as a themeinundergraduate medical education. Med Educ1991 Mar;25(2):135-39.

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APPENDIX A

Use ofPersonal

Computers

in

Family

Practice

I.DEMOGRAPHIC INFORMATION

Sex

Female

Male

Yearofbirth:

Yeargraduated from medicalschool:

Yeargraduated fromresidency: BoardCertification

Yes

No

Population ofPracticeLocation

Lessthan5,000 30,001-50,000

5,000-15,000 50,001-100,000

15,001-30,000 Morethan100,000

12. AssoCIATION OFAMERICAN MEDICAL COLLEGES. Educat-ing medical students: assessing change in medical

educa-tion-theroad toimplementation.Washington,D.C.:The As-sociation, 1992.

13. MANNING PR. Thecomputer and thefuture of continu-ing medical education. In: Medical Informatics [Special

is-sue]. West J Med 1986Dec;145(6):872-73.

14. ROBIE PW, KENDRICK SB, RICHARDS BR. Developing a

computerliteracy curriculum for residents. Acad Med 1992 Oct;67(10):645-47.

15. DEBEHNKE DJ, VALLEY VT. Assessment of the current computer literacy and future needsofemergency medicine residents and faculty. Am J Emerg Med 1993

Jul;11(4):371-73.

16. ROWE BH,RYANDT, THERRIEN S, MULLOY JV. First-year

family medicine residents' use of computers: knowledge, skills and attitudes. CanMedAssocJ 1995 Aug;153(3):267-72.

17. ROBIE,op. cit., 645-47.

18. ROOTENBERG JD. Physicians and computers: future

al-lies?JAMA1990 Apr4;263(13):1859.

19. WEIss BD. Computerapplicationsinfamilymedicine: too

little,too late? FamMed 1994July-Aug;26(7):428-29.

Received September 1997; accepted February 1998

Practice Type

Solo

Smallgroup (2 to4)

Mediumgroup (5 to 10)

Largesinglespecialtygroup (morethan 10) Largemulti-specialtygroup (morethan 10)

Other thanphysicians, how many people areemployed by

yourpractice?

1-2 6-10

3-5 Morethan10

Notapplicable Sizeof LocalHospital

Lessthan50beds 50-100beds 101-200beds

201-500beds Morethan500beds

II. USE OF PERSONAL COMPUTERS

Whatisyourexperiencewithpersonalcomputers? (Checkall that apply.)

Ihaveneverused apersonalcomputer.

I useorhaveused apersonal computerinsomeone's(includingyour own)home.

Iuse orhaveused apersonalcomputerinmypractice.

I use orhaveused a personalcomputerelsewhere.

College Residency

MedicalSchool Other (Where?

Whichoneofthefollowingbestdescribes yourabilityto use a personalcomputer?

_Idonotknowhowto doanything. __Icanturn it on.

Ican runprograms froma menu orusinga mouse.

I can runprograms, managefiles and directories, andcustomizeprogramsettings.

Approximatelyhow oftendoyou use apersonal computer?

Never

Rarely, lessthanonce amonth

Occasionally, atleast once amonth

Regularly, at least once aweek Often, dailyoralmost everyday

How do youfeel aboutyour own abilityto use personal computers?

I do notfeeltheneed tolearn moreabout usingpersonal computers. I wouldliketolearn more aboutusingpersonalcomputers.

How did youlearn to use apersonal computer?(Check allthat apply.) Do notknowhowto use apersonal computer

Primarilyself-taughtthroughreadingandhands-onexperience

Informal instructionfrom friends, colleagues, family, etc.

Classesinhighschoolorcollege

Continuing Education course(s)offeredthroughuniversity, juniorcollege, etc.

Otherworkshops or courses

Other

(How?

Forwhichofthefollowing personalapplications do you use acomputer? (Checkallthatapply.)

Do not use Informationmanagement (personal filingsystems)

Personalfinances Investmenttracking and trading

Personalword processing Education

Personal/private scheduling Games

Electroniccommunications Other(What?

Indicatewho in yourpractice uses apersonal computerforeach of thefollowing applications.

USED BY USED BY

YOU OTHERS APPLICATION

Businesspracticemanagement (accounting,billing, scheduling,etc.)

Clinicalpracticemanagement (medical records, patienthistories, etc.) Patienteducation

Diagnostic programs CME

Databases andbibliographicinformation Electronic bulletin boardsand/or e-mail

Informationmanagement/research(patientdemographics,epidemiology,etc.)

Other (What?

III.ACCESS TO PERSONAL COMPUTERS

How many personalcomputers areavailable foryour use atyouroffice?

How many personalcomputers arelocated inyourhome?

Do youhave amodemavailableforyour use at youroffice?

yes no __donftknow

Do youhavea modemfor apersonal computer at yourhome?

yes no __don't know

Do you belongto a national onlineservice (Prodigy, Compuserve, etc.)?

yes no __don'tknow

IV.INTEREST IN PERSONAL COMPUTERS

Would you be interested inworkshops orcoursesthat wouldhelpyou integrate personalcomputers into your practice?

yes maybe no

Ifyou are interested incomputerworkshopsorcourses, where(how)doyouthinkthey shouldbeheld?(Checkallthatapply.)

Workshopsat Alabama AFP meeting

Week-endworkshopsonthecampus ofTheUniversity of Alabama Evening courses onthecampus ofTheUniversity of Alabama On-lineworkshopsor correspondencecourses using modem Distance-learning using satellite andmodem

Week-end or eveningworkshop at

Other

Indicateyourlevel ofinterest in learning about each of thefollowing applications ofpersonal computers by checking the appropriate box.

NOT

INTERESTED APPLICATION

Business Practice Management Accounting

Filing insuranceclaims

Patient accounts and billing

Patient scheduling Physicianscheduling

Word processing

ClinicalManagement

Computerized medical records Computerized patienthistory

Patienteducation Patient management CME

JournalsondiskorCD-ROM Medicaleducation software "Expert" Programs

"ExpertConsultantintheBox" (e.g., diagnosticsoftware) "Expert ConsultantontheWire"

(e.g., on-lineconsultation)

LEVELOF INTEREST SOMEWHAT INTERESTED VERY INTERESTED Other

Communications softwareto accesselectronic bulletinboards and electronic mail (CompuServe, Internet,etc.)

Informationmanagement/ research (patient

demographics, epidemiology,etc.)

Software toaccessdatabases andbibliographic

information(e.g.,Grateful Med)

APPENDIX B

Use of Personal Computers by

Family

Practice Residents

I.DEMOGRAPHIC INFORMATION

Sex

Female

Male

Year ofbirth:

Year graduated from medicalschool:

Current Status PG1 PG2 PG3 Residency Program Carraway

Medical Center EastProgram Selma/Dallas County Program

TuscaloosaProgram

University of Alabamaat Birmingham

University of Alabama-Huntsville University of South Alabama

Inwhatsizecommunitydoyouplantoestablishyour practice Lessthan5,000 50,001-100,000

5,000-15,000 Morethan 100,000

15,001-30,000 Undecided 30,001-50,000

II. USE OFPERSONAL COMPUTERS

Whatisyour experiencewith personal computers? (Checkallthat apply.)

Ihave never used apersonal computer.

Iuse or haveuseda personalcomputerinsomeone's (includingyourown)home.

I use orhaveuseda personalcomputerelsewhere. Where?

College Residency

Whichone ofthefollowing best describesyour ability to use a personalcomputer? Ido not knowhowto doanything.

Ican tum it on.

Ican run programsfroma menu or using a mouse.

I canrun programs, manage files and directories, andcustomizeprogram settings. I cantroubleshootproblems and makemy system operate to my specifications.

Approximately howoftendo you use apersonal computer?

Never

Rarely, lessthan once amonth

Occasionally,at leastonce a month Regularly, atleast once aweek Often, dailyor almostevery day

Howdo you feel aboutyour ownabilityto usepersonal computers? Idonotfeel theneed to learnmoreaboutusingpersonal computers. Iwould like toleammoreaboutusingpersonal computers.

How did youlearnto use apersonalcomputer? (Checkallthat apply.)

Donotknowhowtouse a personalcomputer

Primarilyself-taughtthroughreading andhands-onexperience

Informalinstructionfromfriends,colleagues, family,etc.

Classesinhigh schoolor college

Continuing Education course(s)offered throughuniversity, juniorcollege, etc.

Otherworkshopsorcourses

Other

(How?

Forwhichofthefollowing personal applications doyou use acomputer? (Checkallthat apply.)

Do not use Informationmanagement(personal filing systems)

Education Investmenttrackingandtrading

Personal finances Games

Personal wordprocessing Other

Personal/private scheduling (What?

Electroniccommunications

Forwhichofthefollowing professional applications doyou use acomputer? (Checkallthatapply.)

Clinicalpractice management "Expert" programs

CME Informationmanagement/research

Databases/bibliographicinformation Patienteducation

Electronic communications Other

(What?

III. ACCESS TOPERSONAL COMPUTERS

Howmanypersonal computers areavailableforyour use in your residencyprogram? Howmanypersonal computers arelocatedinyourhome?

Do youhaveamodem availableforyour use in your residencyprogram?

yes no __don't know

Doyouhaveamodemfor apersonal computer at yourhome?

yes no __don't know

Doyoubelongto anational online service(Prodigy, Compuserve, etc.)?

yes no _ don't know

IV. INTEREST INPERSONAL COMPUTERS

Wouldyou be interested inworkshopsorcourses designedtohelpyou integrate personal computers into your practice?

yes maybe no

Ifyou are interested in computerworkshopsor courses,where (how)to youthink they shouldbeheld? (Checkallthat apply.) Courseinresidency curriculum

WorkshopsatAlabama AFP meeting

Week-endworkshop onthecampus ofTheUniversityofAlabama Evening courses onthecampus ofTheUniversity of Alabama On-lineworkshop orcorrespondence course using modem

Distance-learningusing satellite and modem Week-end oreveningworkshop at

Indicate yourlevelofinterest in learningabouteach of thefollowing applications ofpersonal computers by checking the appropriate box. LEVEL OF INTEREST

NOT SOMEWHAT VERY

APPLICATION INTERESTED INTERESTED INTERESTED

BusinessPractice Management Accounting

Filing insuranceclaims

Patient accounts and billing

Patientscheduling Physician scheduling

Wordprocessing

Clinical Management

Computerized medical records Computerized patienthistory

Patient education Patient management CME

Journalsondisk or CD-ROM

Medicaleducation software "Expert" Programs

"ExpertConsultantin theBox"

(e.g., diagnosticsoftware)

"ExpertConsultantontheWire" (e.g., on-line consultation)

Other

Communications software to accesselectronic bulletin boards andelectronic mail

(CompuServe, Internet, etc.)

Informationmanagement/research (patient

demographics, epidemiology, etc.)

Software to accessdatabases andbibliographic