Original reportEvidence-Based Surgery: Knowledge, Attitudes, and Perceived Barriers among Surgical Trainees
Introduction
The assessment of optimal treatment options based on the best current knowledge is called evidence-based medicine (EBM).1 The practice of EBM has been shown to increase efficiency and the quality of health care.2 It prevents practices that are unsafe and those that lack an evidence base.2 It also makes one aware of the actual evidence on which his practice is based, and in the absence of “hard” evidence, of the weakness of the foundation of his current clinical practice.3
Randomized controlled trials and their systematic reviews form the highest level of evidence currently available to guide clinical practice and often are defined as the reference standards. Evidence from other sources like cohort studies, case series, and case reports is considered inferior in quality and should be used only in the absence of a randomized controlled trial.
Although about half of the interventions in the medical field are found to be based on results of randomized controlled trials,4 only approximately one quarter of the surgical treatments are found to be so.5 In one study, only 3.4% of all publications in leading surgical journals were found to be randomized controlled trials.1
There are many reasons for this lack of high-quality evidence in surgical practice. Surgical randomized controlled trials are often difficult to conduct. There are often difficulties in blinding, standardization of the procedure, using placebos, and eliminating bias. Not all surgical procedures are amenable to randomized controlled trials, and even if so, strict inclusion criteria make the results universally inapplicable.6
In the absence of a randomized controlled trial, the practice of EBM entails finding the current best evidence from other studies and its use in clinical practice.
Studies have shown that even in the presence of high-quality evidence, clinical practice may be different from current best available evidence and, thereby, not evidence based.7, 8 The reasons for this are many. The current apprentice-based approach to surgical training at most hospitals leads to trainees developing practices that are a synthesis of practices of their seniors,8 which may not reflect the best available evidence. The lack of knowledge about EBM and its principles also leads to practice different from the best available evidence.7 It has been shown that education of surgical trainees on the principles of EBM and regular practice sessions based on patient problems leads to successful increase in the use of EBM among surgeons.3
A positive attitude toward EBM7 and the removal of any perceived barriers to its practice are also essential for the practice of evidence-based surgery.
The aim of this study was to assess the attitude and knowledge of surgical trainees toward EBM and their perceived barriers to its practice.7
Section snippets
Methods
The McColl questionnaire9 was used initially to assess the “general practitioner's perceptions to the route to evidence based medicine.” Since its publication in 1998, it has been used widely, with various modifications, to study the attitudes, knowledge, and barriers to practice of EBM in different settings.2, 10, 11 The McColl questionnaire also assesses the understanding of the responder, of common technical terms used in EBM and their access to databases relevant to the practice of EBM.
The
Results
The meeting was attended by 110 surgical trainees. The response rate was 84.5% (93/110). In all, 72 male (77.4%) and 21 female (22.6%) surgeons participated. Nine (10%) surgeons were in their first year of surgical training, 22 (24.4%) were in their second year, and 59 (65.6%) were in their third year. The mean age was 28.8 years (range, 25-52 years).
Discussion
This study examined the attitudes, awareness, and barriers to EBM among surgical trainees in a developing country. Most surgical trainees in this study seem to have a positive attitude toward EBM and seem to agree that its practice improves patient care. Strangely, however, attitudes of colleagues were considered less welcoming than the respondents' own attitudes about EBM (p < 0.0001). Similar findings have been reported in previous studies.2, 9, 10 Although most trainees agreed that research
Conclusions
Surgical trainees have a positive attitude toward EBM and have some familiarity with common terms and methods used in EBM. They seem to have limited knowledge about available sources of medical literature and the techniques of critical appraisal. Most surgical trainees, however, seem to be willing to learn. There is a strong need to include formal training in EBM and basic statistics into the surgical curriculum. An environment favorable to the practice of EBM needs to be built, to promote
References (15)
Evidence-based surgery
Surg Clin North Am.
(2006)- et al.
BARRIERS: the barriers to research utilization scale
Appl Nurs Res.
(1991) - et al.
The Yorkshire BARRIERS project: diagnostic analysis of barriers to research utilisation
Int J Nurs Stud.
(2003) - et al.
Perspectives of evidence-based surgery
Dig Surg.
(2003) - et al.
Attitudes, awareness, and barriers regarding evidence-based surgery among surgeons and surgical nurses
World J Surg.
(2009) - et al.
Evidence-based surgery
Br J Surg.
(2004) - et al.
Inpatient general medicine is evidence basedA-Team, Nuffield Department of Clinical Medicine
Lancet
(1995)
Cited by (23)
Evidence-based practice in radiology: Knowledge, attitude and perceived barriers to practice among residents in radiology
2013, European Journal of RadiologyCitation Excerpt :Similarly, the BARRIERS scale (2) was first designed to find the perceived barriers in practicing evidence based medicine among nurses. These questionnaires have later been used in diverse settings [13–16]. The McColl questionnaire (1) and the BARRIERS scale (2) used were slightly modified in order to make it relevant to radiology.
Evidence-Based Practice: A Survey Among Pediatric Nurses and Pediatricians
2013, Journal of Pediatric NursingCitation Excerpt :Furthermore, the validation of the Barriers scale has been reported (Funk et al., 1991; Kajermo et al., 2010). The usage of dummy terms to explore socially desirable answers has been described in previous studies (Knops et al., 2009; Mittal & Perakath, 2010; Oliveri, Gluud, & Wille-Jorgensen, 2004). Second, the data were gathered from self-reports.
Teaching surgical residents to evaluate scholarly articles: A constructivist approach
2013, American Journal of SurgeryEvidence-based medicine in India
2013, Journal of Clinical EpidemiologyCitation Excerpt :The need to overcome several barriers is obvious but not easily achievable. A study by Mittal and Perakath [14] among surgical trainees found a positive attitude toward EBM, but only 50% of actual practice was considered evidence based. Many clinicians have a misconception that clinical experience or clinical judgment is ignored in EBM, but Karthikeyan and Pais [15] have published a review to correct the misconception and achieve reconciliation.
Quality assurance and quality improvement in medical practice - Part 2
2012, Orvosi HetilapBarriers and facilitators to answering clinical questions in the Americas: A cross-sectional study of surgical trauma care providers
2021, Trauma Surgery and Acute Care Open