Evidence-based Medicine Attitudes Research Articles

Evidence-Based Medicine Attitudes among Residents at Jordan University Hospital: A Cross-Sectional Study

Evidence-Based Medicine Attitudes among Residents at Jordan University Hospital: A Cross-Sectional Study

Knowledge, Attitude, and Practice (KAP) Status toward Clinical Reasoning and Evidence-Based Medicine among the Medical Interns and Gynecology Residents of Iran University of Medical Sciences.

Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P < 0.05). Research experience was associated with better CR-K and all KAP components for EBM (P < 0.05). The total score and many of the KAP components had moderate status for clinical reasoning and EBM. Planning on the associated factors should be regarded in the future. Such questionnaires are suggested to be validated for use in quasi-experimental studies.

A cross-sectional study evaluating the knowledge, attitude, and practice of evidence-based medicine among resident doctors of a health-care Institution of National Importance in India.

Evidence-based medicine (EBM) promotes the integration of updated- best evidence with patient preferences and medical expertise for clinical decision-making. Despite the availability of high-quality evidence such as systematic review and meta-analysis, some clinicians manage their patients based on past experiences and expert opinion. Thus, this study was proposed to assess the knowledge, attitude, and practice of EBM among resident doctors at a tertiary care hospital in India. This cross-sectional questionnaire-based study was conducted among senior residents and final-year postgraduates (PGs) who were independently involved in clinical decision-making. By convenience sampling method, the participants were recruited, and the validated EBM Questionnaire (EBMQ) was distributed online for assessing the knowledge, attitude, and practice of EBM. Descriptive statistics were represented as frequency and proportions. A total of 102 resident doctors participated with male preponderance (74.5%). Nearly, 96 (94.1%) participants were already practicing EBM and 21.6% had undergone EBM training. Textbooks (50%) were the most often referred sources for EBM information. Specific EBM databases such as MEDLINE and Cochrane were also utilized by 37.3% of participants. More than 70% of participants understood the terms such as a randomized controlled trial, case-control study, and P value. A higher proportion (80.4%) of participants showed a positive attitude about patient care improved by EBM. The majority of the resident doctors exhibited good knowledge and a positive attitude toward applying EBM in clinical decision-making. Periodic training through workshops or courses and integration of EBM with the PG curriculum would potentially enhance the EBM practice.

OB-Newborn TEACH Cards: A Curricular Tool for Maternal-Child Rotations That Influences Patient Care.

Evidence-based medicine (EBM) teaching is most successful when integrated with patient care, but finding time for teaching on inpatient rotations is difficult. Obstetrics (OB)-Newborn TEACH (Teaching Evidence-based medicine And Clinical topics in the Hospital) Cards is a curricular tool for efficient teaching sessions on maternity care rotations. We evaluated the impact of OB-Newborn TEACH Cards on resident EBM attitudes and skills, exposure to clinical topics, and patient management. OB-Newborn TEACH Cards includes 56 cards on obstetrics and newborn topics with background and foreground discussion questions. Residents on a family medicine maternal-child service completed pre- and postrotation surveys to assess the cards' impact on EBM attitudes and skills. Faculty and residents also completed point-of-care surveys to assess the self-reported influence on management decisions. Of 24 potential resident participants, 58% completed pre- and postrotation surveys, which showed significant increase in perceived EBM skills like applying evidence to a clinical scenario (P=.04), but a decrease in reported attitudes that EBM is realistic (P=.028) and useful (P=.025). Residents agreed the cards exposed them to a variety of topics. Point-of-care surveys (n=58) indicated that 57% of the time respondents used a card to learn about a topic not related to a specific patient. When used to learn about specific patients, the cards influenced self-reported patient care 44% of the time. OB-Newborn TEACH Cards are a promising inpatient teaching tool for improving perceived EBM clinical application, exposing residents to maternal-child topics, and influencing patient care decisions.

Evidence-Based Medicine Approaches of Students in a Medical School

Aim: To define knowledge and attitudes of Cumhuriyet University Medical School (CUMS) students about Evidence-Based Medicine (EBM) and to determine opinions about the 1-week EBM education given to fourth-year students. Material and Methods: This was a descriptive study on third, fourth, and fifth-year students of CUMS. The 1-week EBM education given in 4th-year is an internship, they can take theoretically and practice lectures. The data collection tool used in research has questioned descriptive features of students, knowledge and attitudes about EBM, and their views on the internship. Results: 165 students volunteered to participate. The most common answers for investigation research question; for 3rd-year students' was general web sites, for 4th-year students' and 5th-year students' was electronic EBM database. While 3rd-year students valued to easy access for searching data, reliability was important for 4th and 5th-year students. The frequency of students' use of electronic databases (p&amp;lt;0.001), the rate of know the keyword as “good” (p=0.021), Medline usage frequency (p=0.003) and mean scores obtained from the pyramid of evidence (p&amp;lt;0.001) have differed significantly between students' years. There was a significant difference between students' English levels and electronic EBM database selection (p=0.034). Students', have upper-intermediate and upper English levels, 72.7%(8) chose the Electronic EBM database source to investigate. The most difficult parts for students when reading an article are their English insufficiency, statistics, and academic language. Students’ opinions about the EBM course; 77.2%(88) found that the course was beneficial, 7.0%(8) said course were not helpful, and 15.8%(18) were undecided. Conclusion: Improving students' English levels could increase their frequency of EBM database usage. It was observed knowledge and attitude of EBM were quite low in 3rd-year students, and general knowledge and attitude of 4th-year students, have received just new internship, were better than the other years. These findings show us that internship is beneficial.

Impact of deliberate practice on evidence-based medicine attitudes and behaviours of health care professionals.

IntroductionAlthough evidence-based medicine (EBM) teaching activities may improve short-term EBM knowledge and skills, they have little long-term impact on learners’ EBM attitudes and behaviour. This study examined the effects of learning EBM through stand-alone workshops or various forms of deliberate EBM practice.MethodsWe assessed EBM attitudes and behaviour with the evidence based practice inventory questionnaire, in paediatric health care professionals who had only participated in a stand-alone EBM workshop (controls), participants with a completed PhD in clinical research (PhDs), those who had completed part of their paediatric residency at a department (Isala Hospital) which systematically implemented EBM in its clinical and teaching activities (former Isala residents), and a reference group of paediatric professionals currently employed at Isala’s paediatric department (current Isala participants).ResultsCompared to controls (n = 16), current Isala participants (n = 13) reported more positive EBM attitudes (p < 0.01), gave more priority to using EBM in decision making (p = 0.001) and reported more EBM behaviour (p = 0.007). PhDs (n = 20) gave more priority to using EBM in medical decision making (p < 0.001) and reported more EBM behaviour than controls (p = 0.016).DiscussionHealth care professionals exposed to deliberate practice of EBM, either in the daily routines of their department or by completing a PhD in clinical research, view EBM as more useful and are more likely to use it in decision making than their peers who only followed a standard EBM workshop. These findings support the use of deliberate practice as the basis for postgraduate EBM educational activities.

Examining aptitude and barriers to evidence-based medicine among trainees at an ACGME-I accredited program

BackgroundThe aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients’ outcome (Profetto-McGrath J, J Prof Nurs Off J Am Assoc Coll Nurs 21:364-371, 2005). Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients’ care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East.MethodsClinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees’ attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed.ResultsThe average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM.ConclusionsWhile it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice.

Attitude and behaviour of Dutch Otorhinolaryngologists to Evidence Based Medicine.

ObjectiveThe objective of this study was to assess the attitude and behaviour of Dutch ENT surgeons and ENT residents towards Evidence Based Medicine.IntroductionEvidence Based Medicine is the cornerstone of modern clinical care. It is considered of crucial importance for optimal patient care and health care quality. Practicing it requires positive attitude and behaviour. Little is known about the attitude and behaviour towards Evidence Based Medicine in otorhinolaryngology.MethodsWe performed a web-based questionnaire among 607 Dutch Ear- Nose & Throat surgeons of whom 106 residents (cross-sectional study). The questionnaire consisted of 3 parts; (1) personal characteristics, (2) questions regarding Evidence Based Medicine attitude (McColl questionnaire, scale 0–100%) and (3) questions regarding Evidence Based Medicine behaviour (barriers and information seeking behaviour). Data were collected between March 26th 2018 and June 1st 2018.ResultsThe median score on the overall McColl questionnaire was 50 (IQR 35). The main barriers respondents experienced were time related. Limited time in the outpatient clinic was considered a more important barrier for residents to practice EBM compared to ENT surgeons. Respondents’ gut feeling and their own preference were identified as the main contributing factors in clinical decision making.ConclusionIn conclusion Dutch ENT surgeons have a moderate attitude on the McColl questionnaire. The main barriers to practice Evidence Based Medicine they experience are time related.

A Longitudinal Evidence-Based Medicine Curriculum and Its Impact on the Attitudes and Perceptions of Student Pharmacists

Objective. To describe a longitudinal evidence-based medicine (EBM) curriculum and to evaluate its impact on the attitudes and perceptions of student pharmacists toward EBM. Methods. Western University of Health Sciences has had a structured, longitudinal, EBM curriculum for more than 10 years, spanning the first to third years, including the introductory experiential experiences. A survey was administered prior to the main EBM course and at the completion of the course at three time periods to assess student pharmacists' attitudes and perceptions of EBM and interactive pedagogical methods. Student pharmacists at Western University of Health Sciences voluntarily participated in the self-administered survey. The three time periods examined included: directly after completion of the EBM course, after completion of the didactic curriculum, and after completion of the advanced pharmacy practice experiences (APPE). Results. The response rates were: pre-survey 94% and post-survey 53%. The three classes surveyed had similar baseline characteristics. Students' perceptions of EBM skills and attitudes improved at all time periods post-course. Students felt strongly both before and after exposure to the EBM course and the longitudinal EBM curriculum about learning new EBM skills and that all pharmacists should have these skills. Significantly more students appreciated all the interactive pedagogical methods after APPE completion (>85% of students), as compared with over 74% of students directly after the EBM course, and over 79% of students after didactic completion. Conclusion. The attitudes and perceptions of student pharmacists toward EBM improved after exposure to a longitudinal EBM curriculum.

Factors associated with practicing evidence-based medicine: a study of family medicine residents.

BackgroundEvidence-based medicine (EBM) plays a critical part in ensuring that practitioners use the soundest available medical procedures while avoiding ineffective ones. As such, it plays a key role in medical residency education. However, little research has shown what factors influence residents’ adoption of habits in, self-efficacy in, and skills of EBM.Materials and methodsThis study gathered responses from a cross section of family medicine residents and new interns from 40 different residencies across the USA. The survey was based on Taylor et al’s survey of EBM attitudes and behaviors and the Fresno test’s assessment of EBM knowledge and skills. The study used negative binomial regression, ordinary least squares regression, and nonparametric tests of difference to assess the impact of residents’ background (year in residency, type of residency, previous EBM training, and previous research experience) on these EBM outcomes.ResultsResidents with previous research experience are associated with stronger EBM habits, more self-efficacy in applying EBM, and greater ability in using EBM skills. Previous research experience had a bigger impact on these outcomes than any other predictor. EBM habits, self-efficacy, and skills did not appear to show even increases by year in residency. Previous EBM training was associated with more hours spent reading the literature and higher EBM skill test scores.ConclusionOur findings suggest the practice of EBM may benefit from medical education increasing research experiences and EBM training. Research experiences provide the practical training, while EBM training provides focused instruction necessary for EBM self-efficacy, habits, and skills. These EBM outcomes are not inherently gained through time in family medicine residency. Future research, particularly longitudinal designs, should continue to pursue this line of inquiry.

Multiple strategy peer-taught evidence-based medicine course in a poor resource setting

BackgroundTeaching Evidence Based Medicine (EBM) is becoming a priority in the healthcare process. For undergraduates, it has been proved that integrating multiple strategies in teaching EBM yields better results than a single, short-duration strategy. However, there is a lack of evidence on applying EBM educational interventions in developing countries. In this study, we aim to evaluate the effectiveness of a multiple strategy peer-taught online course in improving EBM awareness and skills among medical students in two developing countries, Syria and Egypt.MethodsWe conducted a prospective study with pre- and post- course assessment of 84 medical students in three universities, using the Berlin questionnaire and a set of self-reported questions which studied the students’ EBM knowledge, attitude and competencies. The educational intervention was a peer-taught online course consisting of six sessions (90 min each) presented over six weeks, and integrated with assignments, group discussions, and two workshops.ResultsThe mean score of pre- and post-course Berlin tests was 3.5 (95% CI: 2.94–4.06) and 5.5 (95% CI: 4.74–6.26) respectively, increasing by 2 marks (95% CI: 1.112–2.888; p-value <0.001), which indicates a statistically significant increase in students’ EBM knowledge and skill, similar to a previous expert-taught face to face contact course. Self-reported confidences also increased significantly. However, our course did not have a major effect on students’ attitudes toward EBM (1.9–10.8%; p-value: 0.12–0.99).ConclusionIn developing countries, multiple strategy peer-taught online courses may be an effective alternative to face to face expert-taught courses, especially in the short term.

87: KNOWLEDGE, ATTITUDE, AND PRACTICE OF EVIDENCE-BASED MEDICINE AMONG PHYSICIANS: A SYSTEMATIC REVIEW

Background and aims: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...

Evidence-based medicine: A survey among perioperative health care professionals in India.

Background and Aims:Evidence-based medicine (EBM) is defined as the use of scientifically proven evidence for delivering best possible health care to patients. Despite growing emphasis on the need for EBM-based practice, acceptability, and perceptions toward EBM might differ among health professionals. The objective of this study was to assess the attitude, knowledge, and current practices of EBM among perioperative care health professionals in India.Material and Methods:This was a single point paper-based questionnaire survey carried out in February 2014 among delegates registered for an EBM conference on “perioperative care” held at a Tertiary referral Cancer Centre in India. Participation was voluntary and respondents were given the option of remaining anonymous.Results:Out of 190 questionnaires, 123 (65%) were returned. Most respondents (98%) agreed that practicing EBM improved patient care. The need to follow departmental protocols (22%) worries about the cost of implementing new treatments (20%) and inadequate skills to critically appraise articles (16%) accounted for major barriers in implementing EBM in clinical practice, with only 15% of respondents stating reluctance to change set practice. “Randomized controlled trial” and “number needed to treat” were the best and least understood EBM terms. Regarding awareness of 10 commonly used EBM-based guidelines in perioperative medicine, the percentage of correct responses ranged from 20% to 88%.Conclusion:Although most respondents agreed that practicing EBM improved patient care, many of them showed a low level of awareness regarding fundamental aspects of EBM. In addition to encouraging implementation of EBM, there should be increased focus on training in EBM methods.

Knowledge, attitudes, and practice of EBM among physicians

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.

Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

ObjectivesEvidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However,...

A systematic review on barriers, facilities, knowledge and attitude toward evidence-based medicine in Iran

Introduction: Evidence-based medicine (EBM) is the ability and skill in using and integration of the best up-to-date evidences. The aim of this study was a systematic review of barriers, facilities, knowledge and attitude of EBM in Iran. Methods: In this study, database and manual search was used with keywords such as, evidence-based, EBM, evidence-based nursing, evidence-based practice, evidence-based care, evidence-based activities, evidence-based education and their combination with the keywords of the barrier, facilitator, attitude, awareness, prospective, knowledge, practice and Iran. The databases of SID (Scientific information database), Magiran, MEDLIB, PubMed, Google scholar, IranMedex and CINAHL (Cumulative index to nursing and allied health literature) were used for data collection. Results: Finally, 28 papers were included in this study. The lack of facilities, time and skill in research methodology were the most important barriers to EBM. The most and least important factors were orderly creating ample opportunity and detecting needs and problems. The degree of familiarity with the terminology of evidence-based performance was low (44.2%). The textbooks have been considered as the most significant source of obtaining information. The level of awareness, knowledge, and evidence-based performance was less than 50.0%. Conclusion: There are many various barriers in use of EBM and healthcare providers despite the positive attitude toward EBM had a low level knowledge in EBM setting. Consideration of the importance of EBM proper planning and effective intervention are necessary to removing the barriers and increase the knowledge of healthcare providers.

Knowledge, skills and attitude of evidence-based medicine among obstetrics and gynaecology trainees: a questionnaire survey

ObjectivesTo determine current evidence-based medicine skills and practice among trainees.DesignQuestionnaire study.SettingElectronic survey was sent to all obstetrics and gynaecology trainees in East Midlands South Deanery, and responses collected were anonymous.ParticipantsAll obstetrics and gynaecology trainees in East Midland South Deanery.Main outcome measuresSelf-reported attitude, skills and knowledge in various components of evidence-based medicine.Results69 trainees were included in the study of which 35 responded. Among all respondents, almost 72% of trainees use non-evidence-based methods to find answers for their clinical questions, whereas only 18% use appropriate evidence-based medicine practice for such queries. Just 35% of trainees have minimum skills of literature searching. Most of the trainees struggle to understand various components of evidence-based medicine. Nearly 80% of trainees do not have formal education or training with regard to evidence-based medicine.ConclusionsThis study highlights the inadequacy of evidence-based medicine skills among trainees and urges that evidence-based medicine be incorporated in formal training along with specialty study modules.

Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

BackgroundEvidence-Based Medicine (EBM) is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills) in undergraduate medical students with a randomized controlled trial.MethodsThe educational intervention was a one-semester EBM course in the 5th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5th year class (M5 EBM vs. M5 non-EBM groups), and quasi-experimental with static-groups comparisons for the 4th year (M4, not yet exposed) and 6th year (M6, exposed 6 months to a year earlier) groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor’s questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ) test.Results289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM). Critical appraisal skills and attitude scores were higher in the intervention group (M5) and in the group of students exposed to EBM instruction during the previous year (M6). The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (p<0.001, Cohen's d=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test). M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group.ConclusionsFormal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the study, but rigorous follow-up needs to be done to document retention of EBM abilities.

Factors influencing the EBM behaviour of GP trainers: A mixed method study

Background: General practitioner (GP) trainees state that their trainers are not consistent in using evidence-based medicine (EBM) or are even dismissive of it. As trainers are important role models in the Dutch GP training system this could have a large influence on the EBM training of GP trainees.Aim: To establish the motivations and barriers of Dutch GP trainers in using EBM.Methods: A questionnaire on personal characteristics, knowledge, skills (Berlin, score 0–15) and attitude (McColl, VAS score 0–100), and statements about EBM barriers were presented to 106 GP trainers. Additionally, three focus group sessions with trainers (n = 30) were held.Results: Knowledge and skills were less than half correct (mean 6.1, standard deviation (SD) 2.9); the overall score on attitude was 58.8 (SD 9.4). Factor analysis showed four categories of barriers: EBM competence (mean 3.5 (SD 0.8)), search activities (mean 3.5 (SD 0.8)), motivation (mean 3.8 (SD 0.7)) and time (mean 2.5 (SD 0.9)).After analysis of the focus group sessions, five categories of motivations and barriers predominated: EBM competence, attitude and behaviour, sources, time and logistics.Conclusion: GP trainers experience motivations in EBM; however, these motivations can also be barriers, depending on the trainer's level of knowledge and attitude.

Influence of a vertical subject on research in biomedicine and activities of The Cochrane Collaboration branch on medical students' knowledge and attitudes toward evidence-based medicine

AimTo investigate whether the introduction of a vertical subject on research in biomedicine and founding of The Cochrane Collaboration branch at the University of Split School of Medicine influenced students’ knowledge and attitudes toward evidence-based medicine (EBM), including the use of research literature.MethodsWe used a 26-item questionnaire on EBM knowledge and attitudes to survey 1232 medical students of all study years in 3 medical schools in Croatia (Split, Rijeka, Osijek) and the Croatian-speaking medical school in Mostar (Bosnia and Herzegovina).ResultsStudents from the University of Split School of Medicine who had been exposed to the vertical subject on research in biomedicine and activities of The Cochrane Collaboration at the school had better knowledge and more positive attitudes toward EBM. In general, students rarely searched for evidence; 28% of students searched for evidence more than once a month and 96% of students used only textbooks in Croatian and teachers’ handouts, even though 74% of students agreed that articles from scholarly journals were an important supplement for textbooks.ConclusionBuilding up an environment that fosters EBM may be beneficial for students’ knowledge and attitudes toward EBM. Teachers should encourage and require using evidence during all the courses in medical school.