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Objectives Suspected transient ischaemic attack (TIA) necessitates an urgent neurological consultation and a rapid start of antiplatelet therapy to reduce the risk of early ischaemic stroke following a TIA. Guidelines for general practitioners (GPs) emphasise the urgency to install preventive treatment as soon as possible. We aimed to give a contemporary overview of both patient and physician delay. Methods A survey at two rapid-access TIA outpatient clinics in Utrecht, the Netherlands. All patients suspected of TIA were interviewed to assess time delay to diagnosis and treatment, including the time from symptom onset to (1) the first contact with a medical service (patient delay), (2) consultation of the GP and (3) assessment at the TIA outpatient clinic. We used the diagnosis of the consulting neurologist as reference. Results Of 93 included patients, 43 (46.2%) received a definite, 13 (14.0%) a probable, 11 (11.8%) a possible and 26 (28.0%) no diagnosis of TIA. The median time from symptom onset to the visit to the TIA service was 114.5 (IQR 44.0-316.6) hours. Median patient delay was 17.5 (IQR 0.8-66.4) hours, with a delay of more than 24 hours in 36 (38.7%) patients. The GP was first contacted in 76 (81.7%) patients, and median time from first contact with the GP practice to the actual GP consultation was 2.8 (0.5-18.5) hours. Median time from GP consultation to TIA service visit was 40.8 (IQR 23.1-140.7) hours. Of the 62 patients naïve to antithrombotic medication who consulted their GP, 27 (43.5%) received antiplatelet therapy. Conclusions There is substantial patient and physician delay in the process of getting a confirmed TIA diagnosis, resulting in suboptimal prevention of an early ischaemic stroke. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: DN has received expenses and fees for his media work. He holds grant funding from the NIHR School of Primary Care Research and the Royal College of General Practitioners. On occasion, he receives expenses for teaching EBM. ISW reports personal fees from various universities and hospitals around Indonesia for teaching EBM, outside the submitted work. SC occasionally receives expenses for teaching EBM at academic conferences and hospitals around Japan. EJ receives a regular income for his employed NHS work through Yealm Medical Centre and PenARC. He receives expenses for teaching EBM. In March 2019 he received a one-off consultancy fee for 2-days work for Zavamed (work unrelated to this article). PH works as a teacher in EBP and is currently conducting a PhD research that is funded by Avans University of Applied Science. He receives expenses for lectures at seminars and workshops on EBP. HA has received funding from Health Education England to attend the EBHC 2019 meeting. She is also a visiting tutor of Evidence-Based Child Health at the UCL Great Ormond Street Institute of Child Health, London. RCB works as a teacher in EBP and receives a regular income for her employed NIPH (Department of Reviews and health technology assessments) work. None to declare – AL, WMB, C-CC, FB, CE, HTM, SGJ, RT, M-LELB, LP, AKS, PGvP, FB, KAOT, LA.

Objectives: This study aimed to gather and synthesise educational strategies that can improve teaching and learning of evidence-based medicine (EBM) in the workplace, and make them concrete by listing ideas for implementing these strategies. Insight into current workplace-based EBM teaching and learning in general practice was the starting point to generate these strategies and ideas., Design: Exploratory, qualitative focus group study, applying the consensus method of the nominal group technique., Setting: Postgraduate medical education; general practitioner (GP) specialty training at University Medical Centre Utrecht, the Netherlands PARTICIPANTS: 33 GPs and 17 GP trainees, divided in four focus groups. Using opportunistic sampling, participants were selected from the GP workplace because of their role as supervisor or trainee., Main Outcomes: An overview of educational strategies and ideas on how to implement these strategies in the workplace, followed by the participants' global ranking of the most useful ideas., Results: The supervisors and trainees generated a list of educational improvement strategies that can be applied in learning conversations, while observing each other's consultations, and in (multidisciplinary) learning opportunities in the workplace. Table 1 presents the educational strategies and suggestions for implementing them. Ideas regarded as most useful include taking turns to conduct consultations and observing the other, holding a structured, in-depth discussion after observation, preparing and discussing articles found in relevant journals and on-the-spot searching for relevant evidence during learning conversations., Conclusions: Participants provided an extensive list of educational strategies and ideas on how to implement EBM learning in daily practice. As a great deal of GP training takes place in clinical practice, supervisors and trainees could apply the suggested ideas to enhance EBM teaching and learning in the workplace., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)