ArticleImplementation science : IS2017
The physician's experience of changing clinical practice: a struggle to unlearn.
Article in Implementation science : IS, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 103 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
103 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- A conceptual model of factors potentially influencing prescribing decisions for chronic conditions: an overview of systematic reviews.BMC medicine · 2025Pooled it
- Clinical practice guideline recommendations for diagnosis and management of anxiety and depression in hospitalized adults with delirium: a systematic review.Systematic reviews · 2023Pooled it
- Pooled it
- Pooled it
- Reducing Inappropriate Proton Pump Inhibitors Use for Stress Ulcer Prophylaxis in Hospitalized Patients: Systematic Review of De-Implementation Studies.Journal of general internal medicine · 2021Pooled it
- A Systematic Review and Meta-Analysis Evaluating Antibiotic Prophylaxis in Dental Implants and Extraction Procedures.Medicina (Kaunas, Lithuania) · 2018Pooled it
- Use of Parent- and Patient-Reported Outcome Measures in Pediatric Specialty Clinics: A Pilot Randomized Clinical Trial.JAMA network open · 2026Trial
- Printed educational materials directed at Ontario family physicians do not improve adherence to guideline recommendations for diabetes management: a pragmatic, factorial, cluster randomized controlled trial [ISRCTN72772651].BMC family practice · 2021Trial
- Trial
- Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation.Implementation science : IS · 2021Trial
- A New Strategy Against Peri-Implantitis: Antibacterial Internal Coating.International journal of molecular sciences · 2019Trial
- IMPACT Requests: Evaluating the Effectiveness of IMPACT Education for Emergency Department Referrers to Improve the Quality of CT Requests.Journal of medical radiation sciences · 2026Article
- Evaluating the implementation of a deprescribing intervention in Swiss nursing homes: An observational study using qualitative and quantitative methods.Exploratory research in clinical and social pharmacy · 2026Article
- "Just the way we always did it": ophthalmologist perspectives on changing routine anesthesia care for cataract surgery in the United States.Perioperative medicine (London, England) · 2026Article
- Frozen in time: Breaking free from past family practice models.Canadian family physician Medecin de famille canadien · 2026Article
- The optimization of neuroprosthetic interfaces relying on biophysical and surrogate digital twins.npj biomedical innovations · 2026Review
- The Case for Implementation Science in Medical Radiation Practice.Journal of medical radiation sciences · 2026Article
- Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures.Hand (New York, N.Y.) · 2026Article
- Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need.Trauma surgery & acute care open · 2026Article
- Development and implementation of a multifaceted strategy to reduce excessive fasting in an acute surgical setting using the behavior change wheel framework.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2025Article
43 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundChanging clinical practice is a difficult process, best illustrated by the time lag between evidence and use in practice and the extensive use of low-value care. Existing models mostly focus on the barriers to learning and implementing new knowledge. Changing clinical practice, however, includes not only the learning of new practices but also unlearning old and outmoded knowledge. There exists sparse literature regarding the unlearning that takes place at a physician level. Our research objective was to elucidate the experience of trying to abandon an outmoded clinical practice and its relation to learning a new one.
methodsWe used a grounded theory-based qualitative approach to conduct our study. We conducted 30-min in-person interviews with 15 primary care physicians at the Cleveland VA Medical Center and its clinics. We used a semi-structured interview guide to standardize the interviews.
resultsOur two findings include (1) practice change disturbs the status quo equilibrium. Establishing a new equilibrium that incorporates the change may be a struggle; and (2) part of the struggle to establish a new equilibrium incorporating a practice change involves both the "evidence" itself and tensions between evidence and context.
conclusionsOur findings provide evidence-based support for many of the empirical unlearning models that have been adapted to healthcare. Our findings differ from these empirical models in that they refute the static and unidirectional nature of change that previous models imply. Rather, our findings suggest that clinical practice is in a constant flux of change; each instance of unlearning and learning is merely a punctuation mark in this spectrum of change. We suggest that physician unlearning models be modified to reflect the constantly changing nature of clinical practice and demonstrate that change is a multi-directional process.
Indexed as
Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.