IF: 0.644

Medical Information Sources Used by Specialists and Residents in Mashhad, Iran


Masoumeh Sarbaz 1 , 2 , Hamid Reza Naderi 3 , Mohammad Hassan Aelami 4 , Saeid Eslami 1 , 5 , 6 , *


1 Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran

2 Department of Health Information Technology and Medical Records, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, IR Iran

3 Department of Infectious Diseases, School of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran

4 Department of Pediatrics, School of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran

5 School of Pharmacy, Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran

6 Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

How to Cite: Sarbaz M, Naderi H R, Aelami M H, Eslami S. Medical Information Sources Used by Specialists and Residents in Mashhad, Iran, Iran Red Crescent Med J. 2018 ; 20(S1):e22483. doi: 10.5812/ircmj.22483.


Iranian Red Crescent Medical Journal: 20 (S1); e22483
Published Online: March 6, 2016
Article Type: Research Article
Received: August 4, 2014
Revised: September 9, 2014
Accepted: September 29, 2014




Background: Physicians continually need to update their knowledge to ensure appropriate decision making about patient care.

Objectives: We aimed to identify and compare information sources used by specialists and residents, their reasons for choosing these sources, and the level of their confidence in these sources.

Materials and Methods: We conducted a cross-sectional study among specialists and residents using a validated questionnaire in the five academic hospitals affiliated with Mashhad University of Medical Sciences (in northeast Iran). We compared the specialists with residents in term of gender, age, years since graduation, use of information sources, confidence in use of information sources, and reasons for selecting the information sources. Within each group, we also investigated the effect of work experience and gender on frequently used information sources and users’ confidence in them.

Results: The questionnaire was sent to 315 physicians, including 155 specialists and 160 residents. One hundred twenty-six specialists (response rate: 81 %) and 126 residents (response rate: 79%) completed it. The most frequently mentioned sources by all specialists included “English textbooks” (84.9%), “web/internet” (74.6%), “English medical journals” (62.3 %), and “discussions with colleagues” (57%). Among residents, “web/internet” (65.9%), “discussion with colleagues” (61.3%), and “Persian textbooks” (50.4%) were the most frequently used sources of information. In both groups, high confidence was demonstrated in “English textbooks,” “English medical journals,” and “international instructions/guidelines.” Both groups counted reliability, easy accessibility, and being up to date as their primary reasons for the selection of their information sources. There was also a significantly negative correlation between using the internet as an information source and age in specialists (Spearman’s rho=- 0.238, p=0.01), but not in residents.

Conclusions: Reliability, easy accessibility, and being up to date should be considered in establishing information sources for physicians.


Information Sources Physicians Information Seeking Behavior

Copyright © 2016, Iranian Red Crescent Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited

1. Background

Evidence refers to the best current information gathered through clinical care investigations (1). Physicians should be able to systematically seek, analyze, and organize information from a variety of information sources in a timely manner, so that they can make informed decisions about their patients. They will not be able to offer qualified care to their patients unless they update their clinical knowledge (2-5). It is necessary for physicians to apply existing, updated evidence to their practice, so that they can make sure that they have chosen the best and most cost-effective treatments for their patients (6-8).

The results of many studies show that determining proper information sources in order to make informed decisions in health care has become a difficult task. Information source selection depends on success in accessing the favored information in the fastest and most appropriate way (9). The availability of valid information can be considered a cost-effective strategy for the constant improvement of health care services (10).

Different studies have shown that health care staff use electronic sources such as online databases and hand-held devices, medical books, consultation with colleagues, reference books, and scientific journals as information sources (11, 12). A study comparing the information-seeking behaviors of family physicians and specialists showed that family physicians were more likely to search for information related to a specific patient’s problem, while other specialists were more likely to search for the latest research on a specific topic (9). Although there are different studies in the field of physicians’ information-seeking behaviors, there are only few studies on these actions in developing countries (13).

Studies conducted in Iran revealed that the most frequently used information sources for nurses were colleagues (14), whereas general practitioners and faculty members used more books as their information sources (15, 16). Another study compared the use of information sources among specialists, residents, and interns and revealed that specialists use journals, but assistants and interns consider books/reference books when consulting information sources (17).

2. Objectives

This study aims to identify and compare the information sources used by specialists and residents, their reasons for choosing these sources, and the level of their confidence in these sources.

3. Materials and Methods

3.1. Research Setting

A cross-sectional, questionnaire-based study was conducted between August and October 2013in the five academic hospitals affiliated with Mashhad University of Medical Sciences (in northeast Iran).

Mashhad University of Medical Sciences is one of the biggest universities in Iran, with 7000 students in different fields of medicine and several academic hospitals. It is responsible for the health care of 5,994,402 inhabitants.

The investigators visited all clinical departments and personally handed a letter of introduction and questionnaire to each physician. The letter explained the study. The physicians’ participation was voluntary and uncompensated. Agreeing to participate in the study by responding to the questionnaire implied consent.

3.2. Sample

The target population consisted of physicians working in the five academic hospitals affiliated with Mashhad University of Medical Sciences. The criteria for selecting physicians were their willingness to participate and their availability. The questionnaire was offered to 315 physicians, including 155 specialists and 160 residents. A total of 252 physicians completed the questionnaire. We included only specialists (university faculty members), regardless of their grade, specialty, age, or gender, and residents regardless of their age or gender. Based on the sample size calculation formula for a survey, and with a confidence level of 95% and population of 750 persons, we needed a sample size of about 254 subjects.

3.3. Questionnaire Design

We designed our questionnaire based on previous studies and the published literature (9-11, 18, 19). The questionnaire included four parts: (1) the participant’s demographic characteristics (gender, age, occupation, years since graduation); (2) sources of medical information used in clinical practice (“English textbooks,” “Persian textbooks,” “seminar/congress,” “weekly conferences,” “continuing medical education (CME) attended courses,” “CME virtual courses,” “educational classes,” “discussion with colleagues,” “internal instructions/guidelines,” “international instructions/guidelines,” “drug company information,” “media (TV and radio),” “professional newsletters,” “web/internet,” “electronic documents (offline),” “personal notes,” and others); (3) reasons for using information sources; (4) confidence in using information sources.

Two medical informatics specialists and three physicians were asked to provide feedback on the format, clarity, and meaning of questions and response options. Their suggestions were all incorporated in the questionnaire, and minor modifications were made to the questions. Furthermore, a pilot study was conducted to test the questionnaire prior to the main study. To this end, ten physicians working in different units of the hospital were included in the pilot study. The test–retest reliability of the instrument was conducted within two weeks. The participants were also invited to comment on the clarity and comprehensibility of the questionnaire. The threshold for acceptable of test-retest reliability is .75. In this study, the test-retest reliability was 85 percent, which was considered satisfactory or good.

3.4. Statistical Analysis

We used a non-parametric test (Mann-Whitney U) for ordinal data and chi-square for our categorical data to assess the differences between the two groups. We considered significance at the P < 0.05 level. The data were analyzed using the SPSS version 16.0.

3.5. Ethical Approval

The Research Committee of Mashhad University of Medical Sciences (No: 910514-24, approved date: 1.2.2013) approved this study; we also obtained authorization from the hospitals’ managers and supervisors. An anonymous questionnaire was used. Participants’ information confidentiality and privacy were maintained.

4. Results

4.1. Characteristics of the Study Population

In this study, 252 physicians (126 residents (response rate: 79%) and 126 specialists (response rate: 81 %.)) completed the questionnaire. Table 1 shows that most physicians (65.5% specialists vs 61% residents) were male. As predicted, specialists tended to be older than residents and to have more experience in medicine. The average age of specialists was 45 years (SD = 9.5), compared to 32 years for residents (SD = 5.3) (P < 0.001).

Table 1. Characteristics of Specialists (n = 126) and Residents (n = 126) and Statistical Significance of the Differences Between Thema
Gender (N = 237)0.470
Male78 (65.5)72 (61)
Female41 (34.5)46 (39)
Age in years (N = 228)< 0.001
< 303 (2.6)60 (53.1)
30 - 3924 (20.9)44 (38.9)
40 - 4957 (49.6)8 (7.1)
50 - 5919 (16.5)1 (0.9)
60 ≤12 (10.4)0
Years since Graduation (N = 153)< 0.001
1 - 534 (30.6)27 (64.3)
6-920 (18)11 (26.2)
10 - 1214 (12.6)3 (7.1)
≥ 1343 (38.7)1 (2.4)

aData are presented as No. (%).

4.2. The Most Frequently Used Sources of Relevant Information

The most frequently mentioned sources by specialists were “English textbooks” (84.9%), “web/internet” (74.6%), “English medical journals” (62.3 %) and “discussion with colleagues” (57%) (Table 2).

Table 2. Frequency of Use of Information Sourcesa
Use of Information SourcesUse of Information SourcesP-Values
Specialists (n = 126)Residents (n = 126)
AlwaysSomeNeverMedian (Q1,Q3)AlwaysSomeNeverMedian (Q1,Q3)
English Textbook107 (84.9)19 (15.1)03 (3,3)55 (45.8)62 (51.7)3 (2.5)2 (2, 3)< 0.001
Persian Textbooks10 (9.6)67 (64.4)27 (26)2 (1,2)61 (50.4)53 (43.8)7 (5.8)3 (2, 3)< 0.001
English Medical Journals76(62.3)44(36.1)2(1.6)3 (2,3)31 (27)66 (57.4)18 (15.7)2(2, 3)< 0.001
Persian Medical Journals7 (6.6)76 (71.7)23 (21.7)2 (2,2)16 (14.4)48 (43.2)47 (42.3)2(1, 2)0.058
Seminar/Congress33 (27.5)84 (70)3 (2.5)2 (2.3)12 (10.3)64 (55.2)40 (34.5)2 (1, 2)< 0.001
Weekly Conferences30 (25.9)75 (64.7)11 (9.5)2 (2,3)26 (21.7)79 (65.8)15 (12.5)2 (2, 2)0.341
CME (Attended Courses) 24 (20.2)84 (70.6)11 (9.2)2 (2,2)15 (13.3)45 (39.8)53 (46.9)2 (1, 2)< 0.001
CME (Virtual Courses)5 (4.8)53 (51)46 (44.2)2 (1,2)7 (6.2)39 (34.5)67 (59.3)1 (1, 2)0.051
Educational Classes30 (26.8)68 (60.7)14 (12.5)2 (2,3)40 (34.2)57 (48.7)20 (17.1)2 (2, 3)0.650
Discussion with Colleagues69 (57)50 (41.3)2 (1.7)3 (2,3)76 (61.3)43 (34.7)5 (4)3 (2, 3)0.617
Internal Instructions/guidelines29 (25)71 (61.2)16 (13.8)2 (2,2.75)24 (20.3)56 (47.5)38 (32.2)2 (1, 2)0.009
International Instructions/guidelines43 (35.5)68 (56.2)10 (8.3)2 (2,3)18 (15.9)64 (56.6)31 (27.4)2 (1, 2)< 0.001
Drug Company Information 10 (8.6)75 (64.7)31 (26.7)2 (1,2)9 (7.8)68 (58.6)39 (33.6)2 (1, 2)0.288
Media (TV and Radio)2 (1.8)41 (36)71 (62.3)1 (1,2)13 (11.5)53 (46.9)47 (41.6)2 (1, 2)< 0.001
Professional Newsletters5 (4.4)69 (61.1)39 (34.5)2 (1,2)16 (13.8)56 (48.3)44 (37.9)2 (1, 2)0.673
Web/Internet91 (74.6)27 (22.1)4 (3.3)3 (2,3)81 (65.9)41 (33.3)1 (0.8)3 (2, 3)0.183
Electronic Documents (Offline)33 (28.4)76 (65.5)7 (6)2 (2,3)37 (31.9)67 (57.8)12 (10.3)2 (2, 3)0.981
Personal Notes44 (37.9)64 (55.2)8 (6.9)2 (2,3)41 (35.3)66 (56.9)9 (7.8)2 (2, 3)0.660

aData are presented as No. (%).

For the residents, “web/internet” (65.9%), “discussion with colleagues” (61.3%), and “Persian textbooks” (50.4%) were the most frequently used sources of information. Specialists indicated that continuous medical education (CME), virtual courses (44.2%), and professional newsletters (34.5%) were the least frequently used information sources. Also, residents reported that CME virtual courses (59.3%), CME attended courses (46.9%), and Persian medical journals (42.3%) were the least frequently used information sources.

Residents used “English textbooks,” “English medical journals,” “seminar/congress,” “CME (attended courses),” and “(inter)national instructions/guidelines” significantly less than the specialists did (P < 0.001).

4.3. Confidence in Information Sources

The sources that both specialists and residents felt high confidence in were “English textbooks,” “English medical journals,” and “international instructions/guidelines” (Table 3).

Table 3. Confidence in Use of Information Sourcesa
Source of InformationLevel of ConfidenceLevel of ConfidenceP-Values
Specialists (n = 126)Median (Q1, Q3)Residents (n = 126)Median (Q1,Q3)
English Textbooks107 (88.4)14 (11.6)03 (3, 3)107 (89.9)12 (10.1)00.712
Persian Textbooks11 (10.1)79 (72.5)19 (17.4)2 (2, 2)40 (33.6)74 (62.2)5 (4.2)3 (3, 3)< 0.001
English Medical Journals86 (72.9)32 (27.1)03 (2, 3)73 (62.9)39 (33.6)4 (3.4)2 (2, 3)0.076
Persian Medical Journals11 (10.3)80 (74.8)16 (15)2 (2, 2)24 (20.9)64 (55.7)27 (23.5)3 (2, 3)0.836
Seminar/Congress28 (23.9)82 (70.1)7 (6)2 (2, 2)28 (25)70 (62.5)14 (12.5)2 (2, 2)0.534
Weekly Conferences26 (22.4)83 (71.6)7 (6)2 (2, 2)27 (23.5)80 (69.6)8 (7)2 (2, 2.75)0.963
CME (Attended Courses)29 (25.9)77 (68.8)6 (5.4)2 (2, 3)24 (21.6)67 (60.4)20 (18)2 (2, 2)0.041
CME (Virtual Courses)18 (18.6)67 (69.1)12 (12.4)2 (2, 2)15 (13.8)67 (61.5)27 (24.8)2 (1.5, 2)0.036
Educational Classes 38 (34.9)66 (60.6)5 (4.6)2 (2, 3)44 (38.9)61 (54)8 (7.1)2 (2, 3)0.738
Discussion with Colleagues36 (30.5)76 (64.4)6 (5.1)2 (2, 3)38 (32.2)80 (67.8)02 (2, 3)0.408
Internal Instructions/guidelines37 (33)67 (59.8)8 (7.1)2 (2, 3)42 (36.8)54 (47.4)18 (15.8)2 (2, 3)0.744
International instructions/guidelines73(64)36(31.6)5 (4.4)3(2, 3)60 (53.1)50 (44.2)3(2.7)2(2, 3)0.138
Drug Company Information37(33)67(59.8)8 (7.1)2(1, 2)42 (36.8)54 (47.4)18(15.8)3(2, 3)0.256
Media (TV and Radio)2 (1.8)52 (46.8)57 (51.4)1 (1, 2)11 (9.8)54 (48.2)47 (42)2 (2, 2)0.057
Professional Newsletters10 (9.1)73 (66.4)27 (24.5)2 (1.75, 2)14 (12.5)70 (62.5)28 (25)2 (1, 2)0.743
Web/Internet40 (34.8)70 (60.9)5 (4.3)2 (2, 3)60 (52.6)53 (46.5)1 (0.9)2 (1.25, 2)0.004
Electronic Documents (Offline)41 (36)66 (57.9)7 (6.1)2 (2, 3)43 (38.4)64 (57.1)5 (4.5)3 (2, 3)0.617
Personal Notes31 (28.2)70 (63.6)9 (8.2)2 (2, 3)29 (26.1)65 (58.6)17 (15.3)2 (2, 3)0.299

aData are presented as No. (%).

Physicians (both specialists and residents) had the least confidence in the media and professional newsletters. Notably, the specialists had more confidence in CME when compared to residents (P < 0.05). Both the residents and specialists reported that they had low confidence in “Persian medical journals,” and the specialists even had less confidence in “Persian textbooks.”

4.4. The Physicians’ Reasons for the Selection of an Information Source

When some physicians were asked to enumerate their reasons for the selection of information sources in order from “1, the most important,” to “7, the least important,” the specialists counted reliability, easy accessibility, and being up to date with mean scores of 2.9, 3.1, and 3.2 respectively. Residents considered reliability, being up to date, and easy accessibility with mean scores of 2.4, 2.5, and 2.6, sequentially, as their primary reasons for the selection of their information sources (Table 4).

Table 4. Reasons for Selecting the Information Sources and Physicians Preference on a Scale From 1 “the Most Preferred” to 7 “the Least Preferred”
Reasons for SelectingSpecialists aPreference bResidents aPreference b
Reliability105 (83.3)2.9 (2.5)105 (83.3)2.4 (2.1)
Accessibility107 (84.9)3.1 (2.2)108 (85.7)2.6 (2.3)
Being up to date107 (84.9)3.2 (2.5)106 (84.1)2.5 (2.2)
Ease of use95 (75.4)3.7 (1.9)103 (81.7)3 (2.1)
Being concentrated on one source100 (79.3)3.8 (2.2)98 (77.8)3.5 (2.1)
Reduced costs102 (80.9)4.2 (1.9)106 (84.1)3.3 (2.1)
Being in Persian language91 (72.2)4.7 (2.4)100 (79.3)3.8 (2.2)

aData are presented as No. (%).

bData are presented as Mean (SD).

4.5. Comparison of Using Information Sources in Relation to Gender, Work Experience, and Age

There was a significant difference between using some information sources, such as weekly seminars (P = 0.019), personal notes (P < 0.001), and gender, in the group of specialists. Men used more of these information sources then women. For residents, significant differences existed between only using Persian textbooks (P = 0.040), Persian medical journals (P = 0.031), and internal instructions (P = 0.017) in relation to gender. Women were more likely to use Persian textbooks and internal instructions, while men were more likely to use Persian medical journals.

No significant differences existed between using information sources and work experience in either group of physicians (P > 0.05).

There was a positive relationship between using some information sources and age among both specialists and residents (Table 5). Only a significant negative correlation existed between using the internet as an information source and age in specialists.

Table 5. Spearman Correlations Between Using Some Information Sources, or Confidence in Some Information Sources, and Age in Specialists and Residentsz
Information SourcesUsing Information SourcesConfidence in Information Sources
Spearman’s rhoP-ValuesSpearman’s rhoP-ValuesSpearman’s rhoP-ValuesSpearman’s rhoP-Values
English Textbooks--0.273< 0.001NANANANA
English Medical Journals NANA0.352< 0.001NANANANA
Persian Medical Journals NANA0.2160.032NANANANA
Seminar / Congress 0.3000.0010.351< 0.001NANANANA
Weekly Conferences0.265< 0.0010.329< 0.001NANA0.2340.017
CME (Attended Courses) 0.2400.0120.2250.023NANA0.2410.015
CME (Virtual Courses)NANA0.2480.012NANANANA
Educational Classes 0.2390.015NANANANANANA
Drug Company InformationNANA0.254< 0.001NANA0.261< 0.001
Media (TV and Radio)NANA0.2420.014NANA0.2310.020
Professional NewslettersNANA0.2390.014NANA0.280< 0.001
Electronic Documents (Offline)NANA0.355< 0.001NANANANA
Discussion with ColleaguesNANANANA0.2280.0170.388< 0.001
International instructions/ guidelinesNANANANA0.1910.051NANA
Personal notesNANANANANANA0.311< 0.001

zAbbreviation: NA, No statistically significant correlation available.

4.6. Comparison of confidence in Information Sources in Relation to Gender, Work Experience, and Age

There was a significant difference between confidence in some information sources, such as personal notes (P < 0.001) and discussions with colleagues (P = 0.012), in relation to gender in the group of specialists. Men had more confidence in these information sources.

Also, significant differences existed between confidence in some information sources, such as CME (attended courses) (P = 0.029) and CME (virtual courses) (P = 0.013) and work experience. These sources were used more often by specialists who had more work experience.

In the group of residents, women had more confidence in seminars / congresses (P < 0.001), CME (attended courses) (P = 0.043), internal instructions (P < 0.001), drug company information (P = 0.043), and the internet (P = 0.027) than men did. In this group, there was no significant difference between confidence in information sources and work experience (P > 0.05).

There is a positive relationship between confidence in some information sources and age in both groups of physicians (Table 5).

5. Discussion

The results obtained from the present study showed that the use of English textbooks, web/internet, and English medical journals are the most frequently chosen sources by specialists searching for medical information, while, for residents, the most used sources are web/internet, discussions with colleagues, and Persian medical sources.

Previous studies have concluded that printed books and journals were the most trusted information sources, which is inconsistent with the findings of the present study (19, 20). Kapiriri and Bondy reported that physicians’ statements and “discussions with colleagues” followed by textbooks, were the most frequently used sources of information for physicians who participated in their study (10). They showed that reliability is the most important reason for selecting an information source. Moreover, in accordance with our results, a review of confidence levels in different information sources showed that specialists and residents have the most confidence in English textbooks. Cullen’s research showed that general practitioners mostly rely on medical journals and books, rather than other sources, especially the internet/web (21). However, our results showed that, among residents who are younger and belong more to the Internet Age than specialists, the internet was the first preferred information source. Our findings support previous research indicating that residents use internet as the most important information source (22). The physicians’ unfamiliarity with online instruments and the great deal of information demanding “information literacy” for access were mentioned as the reasons of the low usage and confidence to online sources (9). In this respect, also the findings about information sources’ use in relation to specialists’ ages showed that there is a significant relationship between using the web/ internet as an information source and age.

Among existing textbooks, the findings showed that texts in the Persian language were used less by physicians (specialists and residents) than texts in English. However, the specialists had less confidence in Persian textbooks compared to the residents. These texts are usually translated from the English language. One reason for this lack of confidence could be related to translation problems, such as an incomplete understanding of the original content and intent of the original authors. Therefore, physicians prefer to refer to the original texts. In addition, Persian textbooks are not updated in a timely manner. Specialists are usually looking for information that has been recently produced in English, whereas residents are looking for basic information that is available in Persian-language books that have been recommended by specialists. This can explain the difference in the level of confidence between specialists and residents relating to Persian-language books.

Discussions with colleagues has the most effect on physicians’ decision making, compared to other information sources (10). In addition, discussions with colleagues were sometimes mentioned as the easiest and most quickly accessible source of information among physicians (18, 23-28). However, in the current study, discussions with colleagues was the fourth preferred source for specialists and the second among the residents, with only average levels of confidence cited by both groups.

Among the different sources studied in this research, the media, professional newsletters, and CME courses were mentioned as the less frequently used ones by both groups. Reviewing confidence levels in these sources showed that they also had the least level of physicians’ confidence. Despite the positive features of these sources, such as their low cost and being in Persian, it seems that physicians do not use these sources. More effort and better programs are needed to improve the level of use and confidence in these potentially useful sources. The confidence of specialists with more work experience was higher for “CME courses.” Also, specialists had more confidence in the CME, as compared to residents. It seems that the specialists, as lecturers and organizers of these courses, have more confidence in them, compared to the residents who participate in the courses as learners.

Despite the strengths of this study, which include its high response rate, it has some limitations. First, this study was carried out in a specific area, which makes its generalization for other areas difficult. Second, the participants of this study belonged to different specialty fields; hence, the next studies might be done about different specialties separately, where comparisons might lead to different, valuable conclusions. Another limitation of the study is related to its sampling method. The authors selected the samples here based on availability and willingness to participate.

In conclusion, available, trusted, and up to date information sources can improve treatment results and health care services by contributing to the efficient use of sources and a reduction of the time spent by physicians researching information. As continuing medical education is seldom used as a popular information source, attention should be paid to revising current educational programs and methods. Also, improving access to English-language resources through hospital libraries could be effective, considering the high confidence of the physicians in English-language medical literature.



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