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

Advances in Medical Education and Practice Dovepress open access to scientific and medical research ORIGINAL RESEARCH Open Access Full Text Article Advances in Medical Education and Practice downloaded from https://www.dovepress.com/ For personal use only. Factors associated with practicing evidence-based medicine: a study of family medicine residents This article was published in the following Dove Press journal: Advances in Medical Education and Practice Justin Paulsen 1 Morhaf Al Achkar 2 1 School of Education, Indiana University, Bloomington, IN, USA; 2 School of Medicine, University of Washington, Seattle, WA, USA Background: Evidence-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 methods: This 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. Results: Residents 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, selfefficacy, 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. Conclusion: Our 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. Keywords: evidence-based medicine, education, medical, internship and residency, family practice, surveys and questionnaires Introduction Correspondence: Justin Paulsen Indiana University, School of Education, 201 N. Rose Suite 4000, Bloomington, IN 47405-1006, USA Tel +1 832 244 1422 Email Evidence-based medicine (EBM) is “the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients”.1 This approach integrates the latest research findings and clinical experience into individualized patient care.2 In this sense, EBM is crucial for the implementation of beneficial and effective health care practices and the abandonment of harmful or ineffective ones.1 Thus, EBM aims to help doctors make evidence-informed decisions in order to potentially reduce variation in medical decisions and to improve outcomes.3,4 287 submit your manuscript | www.dovepress.com Advances in Medical Education and Practice 2018:9 287–293 Dovepress © 2018 Paulsen and Al Achkar. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/AMEP.S157792 Dovepress Paulsen and Al Achkar Although the concepts surrounding EBM have been highlighted in medical education for decades, many residents and physicians lack the skills and knowledge to practice EBM.5 Many barriers for implementing EBM in practice have been identified.2 Negative attitudes toward EBM and a lack of familiarity with this approach are among the top barriers: doctors who viewed EBM as only “research-based decision[s]” that neglect “clinical expertise” were less likely to employ this perspective.2 Other important barriers for implementation include lack of EBM competencies and knowledge and skills as well as non-conducive teaching styles.2 The culture of practice, on the other hand, can counteract such barriers: a culture that cultivates respectful and reciprocal communication seems to encourage EBM.3 While the literature has identified key barriers, more research is needed about how residents develop and use their EBM skills. Several review studies of scores of EBM implementation studies have examined the impacts of different EBM instructional techniques.6 While these studies have found that multifaceted, clinically integrated approaches are generally effective for residents, they have also found that gains in EBM knowledge or skills diminish over time.6 Additionally, previous studies showed limited success in helping residents develop these EBM skills and knowledge, especially in contrast to medical students.7,8 Finally, most studies do not consider residents’ previous experience when assessing their changes in EBM capacities, and thus, we have limited understanding on which experiences matter more in terms of long-term EBM development. Thus, we aim to provide insight into what experiences are associated with residents’ development of EBM attitudes, habits, and skills. Various approaches for measuring EBM have been used in the literature. Evaluating EBM’s benefit to patients and learner’s behavior may require the use of patient-specific outcomes and active monitoring of learners.9 However, attitudes, self-efficacy, and skills are easier aspects for assessment and they can be evaluated using self-administered assessment tools.9 A systematic review identified a variety of instruments, many of which have limited validity.10 Among these tests, the Fresno Test has probably been used the most extensively, with over 300 citations and validations of variations of the test. We similarly chose the Fresno test to assess residents’ skills in EBM.11 Among EBM instruments, the one by Taylor et al is valuable because it has been shown to reliably measure EBM habits and self-efficacy.12 Using multiple measures increases confidence in effectively understanding complex variables such as EBM.13 288 s (...truncated)