Abstract
Although efforts are made to integrate evidence-based medicine (EBM) into clinical practice, physicians experience significant barriers to its implementation. The aim of this study is to quantify the barriers that general practice (GP) trainees experience when using EBM in practice. In September 2008, a questionnaire was administered to 140 GP trainees from three Dutch GP Speciality Training Institutes. The questionnaire focused on barriers that GP trainees meet when using EBM in practice. Factor analysis identified components in which barriers exist, and the validity and reliability of the questionnaire were established. After removing four items that did not fit the questionnaire structure, factor analysis identified three relevant components. All three components had similar mean scores, indicating a similar negative influence of these components on the practice of EBM: knowledge/skills (α = 0.72, mean score 2.9 ± 0.8), attitude (α = 0.70, mean score 2.9 ± 0.6), and external factors (α = 0.66, mean score 3.0 ± 0.5). The barrier that trainees experienced most was lack of time to practise EBM. Barriers to the use of EBM were present in three components: knowledge/skills, attitude, and external factors.
Highlights
Evidence-based medicine (EBM) was introduced in 1992 [1]
In order to determine how the questionnaire would be received, we presented the questionnaire to a panel of four physicians and four evidence-based medicine (EBM) experts and asked whether they thought the questionnaire was suitable for surveying EBM barriers in general practice (GP) trainees
Face validity was positive; all panel members agreed that the questionnaire reflects the barriers that GP trainees experience in their use of EBM and that the questionnaire is suitable for general practice
Summary
Evidence-based medicine (EBM) was introduced in 1992 [1]. Formal EBM education usually focuses on the ability of trainees to use the well-known fivestep model: ask, access, appraise, apply, and audit [2]. During EBM education, ideally, each step is thoroughly discussed and the translation of the critically appraised evidence into clinical practice is taught [2] (Fig. 1). The transfer of evidence into practice is not optimal [3] and barriers limiting the use of EBM are met by both trainees [4] and their clinical trainers [5]. In order to optimize the transfer of evidence into patient care—through installing EBM education in practice [6]—current barriers need to be tackled. An overview of the barriers that are encountered in the practice of EBM by general practice (GP) trainees could help to define which barriers are present, but could help to determine the relative importance of these barriers, allowing trainers to focus on specific components hindering the use of EBM
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