Papers by Allen Shaughnessy
Becoming an information master: a guidebook to the medical information jungle
The Journal of family practice, 1994
The medical information system is a "jungle" in which the unguided visitor can become l... more The medical information system is a "jungle" in which the unguided visitor can become lost or disoriented. This paper, the second in a series on becoming a medical information master, is a guidebook for traveling through this jungle. It focuses on techniques for efficiently obtaining patient-oriented evidence that matters (POEM). From original research to clinical experience, each source of medical information is valuable; the trick is to learn which source is best for the specific information being sought. Armed with this guide, clinicians can find the most appropriate source of information, evaluate it quickly, and apply it confidently in their efforts to provide the best care for their patients.
Journal of religion and health, 2017
This qualitative study introduces the broad and inclusive concept of the "inner life of phys... more This qualitative study introduces the broad and inclusive concept of the "inner life of physicians" and analyzes the written reflections (N = 756) of family medicine residents (N = 33) during their residency as indicative of the physicians' inner lives. Residents completed reflective entries without specific prompts. Researchers describe unsolicited emergent categorical themes indicative of a robust inner life of the physician. Nurturing physicians' inner life through reflection allows physicians to recognize, identify, and respond to daily emotional events. Reflections about the state of physicians' inner lives can formulate and express fundamental human questions that concern: (a) troubling human experiences (e.g., suffering, death, luck, destiny, and death); (b) questions that surface in practicing their profession; (c) spiritually explicit questions on their beliefs and practices. Physicians' inner lives can become a "place" where physicians l...
Clinical practice guidelines abound. The recommendations contained in these guidelines are used n... more Clinical practice guidelines abound. The recommendations contained in these guidelines are used not only to make decisions about the care of individual patients but also as practice standards to rate physician " quality. " Physicians' confidence in guidelines is based on the supposition that there is a rigorous, objective process for developing recommendations based on the best available evidence. Though voluntary standards for the development of guidelines exist, the process of guideline development is unregulated and the quality of many guidelines is low. In addition, the few tools available to assess the quality of guidelines are time consuming and designed for researchers, not clinicians. Few guidelines are evaluated, either before or after their dissemination , for their impact on patient outcomes. Just as with pharmaceuticals and other products that can affect patients for better or worse, perhaps it is time to develop more standardized ways to evaluate the development and dissemination of clinical practice guidelines to ensure a similar balance between risk and benefit. (J Am Board Fam Med 2016;29:644 – 648.)
BACKGROUND AND OBJECTIVES: Teaching evidence-based medicine
is becoming more frequent in family m... more BACKGROUND AND OBJECTIVES: Teaching evidence-based medicine
is becoming more frequent in family medicine residency education,
as is the teaching of information mastery, which is using
techniques to answer clinical questions at the point of care and
to keep up with changes in medical knowledge. The goal of this
study was to determine the effect of an integrated curriculum of
information mastery on residents’ evidence-based medicine knowledge
and skills as well as their confidence at critically appraising
medical literature and using evidence to inform clinical decisions.
METHODS: We used a before-after study in a single residency over
5 years. Residents completed the Fresno Test of Evidence-based
Medicine and an attitude questionnaire at the start of the curriculum
and then again before graduation. The integrated curriculum
consisted of intensive instruction over the course of 1 month (30
hours), followed by a longitudinal series of ongoing conferences,
integrated into the teaching of clinical content. Teaching was also
integrated into day-to-day clinical activities via precepting interactions.
RESULTS: Twenty-three residents completed the study. Modified
Fresno Test scores significantly improved from 104.0 to 121.5. Using
a pass/fail approach, nine residents (40.1%) passed the test
at the start of training, increasing to 17 (73.4%) at the end of
the intervention. Confidence in critical appraisal scores increased
from an average 17.90 (95% CI=16.55–19.25) to 21.10 (95%
CI=19.49–22.71), out of a possible score of 25. Confidence scores
were significantly lower in residents who did not pass the posttest
(18.5 versus 21.9). Attitudes regarding confidence in the use of
evidence and a decreased reliance on experts were also improved
following the curriculum.
CONCLUSIONS: A curriculum of information mastery, integrated
across the greater curriculum, improved trainees’ evidence-based
medicine knowledge and skills and attitude toward using evidence
to inform clinical decision making.
Two-Hour Algorithm to Rule In or Rule Out Acute MI
American family physician, 2015
Hand Washing Children's Dishes Associated with Fewer Allergies
American family physician, 2015
Walking Program Effective for Chronic Low Back Pain
American family physician, 2015
Spinal Stenosis: Physical Therapy Before Surgery
American family physician, Jan 15, 2015
Physician Assessment of COPD Does Not Match Spirometry Results
American family physician, 2015
Acetaminophen (Paracetamol) Minimally Effective for Back Pain and Osteoarthritis
American family physician, 2015
Family medicine residents' reactions to introducing a reflective exercise into training
Education for health (Abingdon, England)
Teaching residents how to reflect and providing ongoing experience in reflection may aid their de... more Teaching residents how to reflect and providing ongoing experience in reflection may aid their development into adaptable, life-long learning professionals. We introduced an ongoing reflective exercise into the curriculum of a family medicine residency program. Residents were provided 15 minutes, three times a week, to complete these reflective exercises. We termed these reflective exercises "clinical blogs" since they were entered into a web-based computer portfolio, though they were not publicly available. The aim of this study is to explore family medicine residents' responses to the introduction of an ongoing reflective exercise and examine strengths and challenges of the reflective process. We invited a cohort of family medicine residents (8 residents) who had all participated in the reflective exercises as part of their residency to participate in one of two offered focus groups to share their experience with the reflective exercise. An investigator not connected...
Pharmacists are on the health care team, too
JAAPA: official journal of the American Academy of Physician Assistants
Calcium channel blockers for migraine prophylaxis
JAAPA: official journal of the American Academy of Physician Assistants
The Journal of family practice
Case series show that hypokalemia following initiation of diuretic therapy occurs in most patient... more Case series show that hypokalemia following initiation of diuretic therapy occurs in most patients within 2 to 8 weeks. However, no studies are available that adequately predict the risk of this complex and multifactorial condition. Patients taking diuretics should have a potassium level checked in the first 2 to 8 weeks after initiating therapy. Mild hypokalemia (3.1 to 3.4 mmol/L) may be transient, so a repeat measurement may be considered before initiating potassium replacement. Dietary sodium restriction may also help to conserve potassium, because this will decrease urinary flow rate and potassium loss. The frequency with which to check potassium levels should be guided by the patients' underlying clinical conditions and dietary potassium and sodium intake. (Grade of Recommendation: C, based on case series)
Spironolactone in left-sided heart failure: how does it fit in?
American family physician
The familiar diuretic spironolactone has taken on new life as a treatment for left-sided congesti... more The familiar diuretic spironolactone has taken on new life as a treatment for left-sided congestive heart failure. Spironolactone has been shown to decrease mortality in such patients who are New York Heart Association class IV. It can be used in addition to agents such as angiotensin-converting enzyme inhibitors and beta blockers, which also decrease mortality, and diuretics and digoxin, which are useful in treating symptoms. Spironolactone is safe, easy to use and reasonably priced. More research is necessary to determine the order and combinations of these medications in slowing the progression of this disease.
Probiotics use decreases antibiotic-associated diarrhea
American family physician
Prevention of osteoporosis
The Journal of family practice
The Journal of family practice
In patients with diabetes and hypertension, should treatment hypertension, should treatment start... more In patients with diabetes and hypertension, should treatment hypertension, should treatment start with an ACE inhibitor instead start with an ACE inhibitor instead of a diuretic or beta blocker? of a diuretic or beta blocker?
Honey improves nocturnal cough in children
American family physician
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Papers by Allen Shaughnessy
is becoming more frequent in family medicine residency education,
as is the teaching of information mastery, which is using
techniques to answer clinical questions at the point of care and
to keep up with changes in medical knowledge. The goal of this
study was to determine the effect of an integrated curriculum of
information mastery on residents’ evidence-based medicine knowledge
and skills as well as their confidence at critically appraising
medical literature and using evidence to inform clinical decisions.
METHODS: We used a before-after study in a single residency over
5 years. Residents completed the Fresno Test of Evidence-based
Medicine and an attitude questionnaire at the start of the curriculum
and then again before graduation. The integrated curriculum
consisted of intensive instruction over the course of 1 month (30
hours), followed by a longitudinal series of ongoing conferences,
integrated into the teaching of clinical content. Teaching was also
integrated into day-to-day clinical activities via precepting interactions.
RESULTS: Twenty-three residents completed the study. Modified
Fresno Test scores significantly improved from 104.0 to 121.5. Using
a pass/fail approach, nine residents (40.1%) passed the test
at the start of training, increasing to 17 (73.4%) at the end of
the intervention. Confidence in critical appraisal scores increased
from an average 17.90 (95% CI=16.55–19.25) to 21.10 (95%
CI=19.49–22.71), out of a possible score of 25. Confidence scores
were significantly lower in residents who did not pass the posttest
(18.5 versus 21.9). Attitudes regarding confidence in the use of
evidence and a decreased reliance on experts were also improved
following the curriculum.
CONCLUSIONS: A curriculum of information mastery, integrated
across the greater curriculum, improved trainees’ evidence-based
medicine knowledge and skills and attitude toward using evidence
to inform clinical decision making.
is becoming more frequent in family medicine residency education,
as is the teaching of information mastery, which is using
techniques to answer clinical questions at the point of care and
to keep up with changes in medical knowledge. The goal of this
study was to determine the effect of an integrated curriculum of
information mastery on residents’ evidence-based medicine knowledge
and skills as well as their confidence at critically appraising
medical literature and using evidence to inform clinical decisions.
METHODS: We used a before-after study in a single residency over
5 years. Residents completed the Fresno Test of Evidence-based
Medicine and an attitude questionnaire at the start of the curriculum
and then again before graduation. The integrated curriculum
consisted of intensive instruction over the course of 1 month (30
hours), followed by a longitudinal series of ongoing conferences,
integrated into the teaching of clinical content. Teaching was also
integrated into day-to-day clinical activities via precepting interactions.
RESULTS: Twenty-three residents completed the study. Modified
Fresno Test scores significantly improved from 104.0 to 121.5. Using
a pass/fail approach, nine residents (40.1%) passed the test
at the start of training, increasing to 17 (73.4%) at the end of
the intervention. Confidence in critical appraisal scores increased
from an average 17.90 (95% CI=16.55–19.25) to 21.10 (95%
CI=19.49–22.71), out of a possible score of 25. Confidence scores
were significantly lower in residents who did not pass the posttest
(18.5 versus 21.9). Attitudes regarding confidence in the use of
evidence and a decreased reliance on experts were also improved
following the curriculum.
CONCLUSIONS: A curriculum of information mastery, integrated
across the greater curriculum, improved trainees’ evidence-based
medicine knowledge and skills and attitude toward using evidence
to inform clinical decision making.