Knowledge, attitudes, and practice of EBM among physicians

Abstract

Background: Evidence-based practice, defined as the systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients, has been encouraged among physicians worldwide. We conducted a systematic review of articles assessing knowledge, attitude, and practice of graduate physicians towards evidence-based medicine (EBM) and the barriers to the implementation of EBM. Methods: Medline, Google Scholar, and ERIC were searched systematically with appropriate search terms up to February 2016. References of the articles detected by search were screened for any missed articles evaluating knowledge, attitude, or practice of EBM among physicians. Studies with a qualitative design and those merely evaluated implementation of clinical practice guidelines were excluded based on abstracts. The studies were assessed regarding their instruments. Results: Out of 55 articles finally included in our study, 15 studies evaluated the study parameters among primary care physicians and the remaining studies evaluated residents (n = 12) and specialists. The most commonly used (n = 23) questionnaire was the one developed by McColl et al in 1998 which evaluated self-reported awareness, attitudes, and barriers towards EBM. Knowledge and attitude were reported by most of the studies. 16 studies reported the practice of EBM. Discussion: Regarding the tools to assess knowledge, attitude, and practice of EBM, we found that the current questionnaires may have relatively adequate strength to measure attitude, but are subjective and indirect measures of awareness rather than knowledge. Moreover, some of the less commonly used tools were more objective and practical than the ones most commonly used. The physicians have a generally positive attitude towards EBM and most of them believe that its implementation improves patient care. However their self-reported awareness and knowledge regarding common terms used in EBM and the main databases is generally poor. Both knowledge and attitude have improved through years after the introduction of EBM and specialists generally have a more positive attitude and better knowledge towards EBM than primary care physicians. Common reported barriers included lack of time and skills with only a minority of physicians (mainly from developing countries) citing lack of facilities as a barrier. Conclusion: Findings from our review indicate that more effective EBM courses in the medical schools which improve physicians’ skills in different steps of EBM are probably the most effective area for intervention to improve EBM knowledge, attitude, and practice among physicians.