Barriers to Incorporating NICE Clinical Practice Guidelines in Medical Education: The Medical Student’s Perspective

Abstract

Clinical practice guidelines (CPG) developed by the National Institute for Health and Clinical Excellence (NICE) aim to address National Health Service (NHS) practice inequalities by supporting clinicians deliver best patient care to address practice inequalities. As the future NHS workforce, it is important to quantify medical students’ knowledge of and attitude towards evidence based medicine (EBM) and NICE CPGs to identify barriers influencing evidence based medicine and CPG implementation. We administered an online survey to medical students in England and Wales to study attitudes and knowledge of EBM and CPGs. We performed Mann-Whitney and Kruskal-Wallis tests to compare different groups’ continuous variable means. We received 323 responses across seven medical schools. A scale reliability alpha of 0.71 reflected satisfactory questionnaire internal consistency. Students were unsure regarding development processes such as 3 year implementation timeframes (74%) and role of academic medical colleges, drug companies and lay public. Students understood the scientific evidence application in decision-making processes (83%) and that clinicians should practice EBM (87%). 77% and 51% of students believe CPG’s influence drug availability and decrease practice autonomy respectively. Two thirds of students felt guidelines reduced patient choice. The majority of medical students understood the importance and role of evidence based medicine and NICE guidelines. However, poor knowledge on processes of guideline development and negative views on aspects of NICE CPGs may be construed as barriers that may affect implementation in future evidence-based practice. Research is warranted to develop an educational framework for future educational strategy implementation.