Do checklist-induced behavioral changes improve self-confidence in fundoscopic examination?: A mixed-methods study

Abstract BackgroundFundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that Implementation frequency is low. We quantitatively verified increases in exam implementation for patients suggested for fundoscopic exams, as well as improvements in physicians' confidence in the procedures, by introducing a checklist. We also conducted a qualitative analysis in order to clarify the process by which they gain confidence in examination procedures.MethodsThis study is a before-after study, within an embedded-experimental mixed methods design. Phase 1 spans April to May 2016, April to May 2017, and October to November 2017. Phase 2 spans the two months following each phase 1 period. We sampled 15 physicians in department of general medicine at a university hospital assigned to initial consultation. The introduction of a checklist that verifies whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values ​​for the confidence in procedure are measured between the two phases. To analyze, we obtained qualitative data from interviews and used the Modified Grounded Theory Approach.ResultsWe observed significant increases in the implementation ratio (19.2% (29/151 cases) vs. 64.8% (105/162 cases), p<0.001), and in the VAS value for the confidence (1.89mm vs 4.68 mm (p<0.001)) between the two phases. Analysis of the interviews produced five themes from the initial 632 codes, 31 concepts (with <>), and 8 categories. To increase the implementation, it is necessary to reduce the and , which is preventing by the checklist. The leads to a . Repeated executions result in .ConclusionsThe intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.