Elsevier

Journal of Surgical Education

Volume 67, Issue 5, September–October 2010, Pages 278-282
Journal of Surgical Education

Original report
Evidence-Based Surgery: Knowledge, Attitudes, and Perceived Barriers among Surgical Trainees

https://doi.org/10.1016/j.jsurg.2010.06.012Get rights and content

Objectives

This study was conducted to assess the knowledge and attitude of surgical trainees toward evidence-based medicine (EBM) and their perceived barriers to its practice.

Design

The McColl questionnaire and the BARRIERS scale were modified and incorporated into a single questionnaire, which was administered to all surgical trainees attending a Continuing Surgical Education meeting.

Setting

Department of Surgery, Christian Medical College, Vellore, India.

Participants

One hundred ten surgical trainees from 22 medical colleges.

Results

In all, 84.5% (93/110) trainees returned the questionnaire. The attitudes toward EBM were welcoming, although individual participants reported they welcomed EBM more than their colleagues did. Participants agreed that EBM was useful in everyday practice and that it improved patient care. About 50% of actual practice was considered evidence based. In all, 12.6% (10/89) of participants had received formal training in EBM, and 64.3% (54/84) of participants were aware of the Cochrane database of systemic reviews, but only 35.7% (30/84) read it regularly. Also, 67.8% (61/90) of respondents used protocols and guidelines developed by colleagues. However, 61.5% (56/91) of participants were interested in learning the skills of EBM. The terms absolute risk, relative risk, and clinical effectiveness were understood by >80% of respondents, whereas publication bias, confidence interval, and heterogeneity were poorly understood. The major barriers to practice of EBM were the inability to understand statistical analysis, inadequate facilities for implementation, lack of a single compiled source of literature, relevant literature not being readily available, and insufficient time on the job.

Conclusions

Surgical trainees have a positive attitude towards EBM and have some familiarity with the common terms used in EBM. There is a need to increase awareness of, and provide access to, available sources of medical literature. Formal training in EBM, as well as basic statistical analysis, should form a part of the surgical curriculum to foster an environment favorable to the practice of EBM.

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)

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