Challenges to the Practice of Evidence-Based Medicine during Residents’ Surgical Training: A Qualitative Study Using Grounded Theory

Bhandari, Mohit; Montori, Víctor M.; Devereaux, P. J.; Dosanjh, Sonia; Sprague, Sheila; Guyatt, Gordon

doi:10.1097/00001888-200311000-00022

Cited by 89 publications

(79 citation statements)

References 14 publications

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“…Evidence-based medicine has been implemented in some surgical residency programs and has been found to be beneficial in many cases (Bazarian et al 1999, Edwards et al 2002, Bhandari et al 2003b, Grant 2005, Nicholson and Shieh 2005 (Hurwitz et al 2000). With the increase in healthcare costs due to new techniques and an aging population, it may be necessary to move towards using interventions that are based on high-quality clinical research with patient-important outcomes and demonstrated cost-effectiveness .…”

Section: Overviewmentioning

confidence: 99%

Misconceptions about practicing evidence-based orthopedic surgery

Poolman¹,

Petrisor²,

Marti³

et al. 2007

Acta Orthopaedica

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Section: Overviewmentioning

confidence: 99%

Misconceptions about practicing evidence-based orthopedic surgery

Poolman¹,

Petrisor²,

Marti³

et al. 2007

Acta Orthopaedica

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“…Although this survey did not directly address the underlying reasons for this limited familiarity, Bhandari and colleagues, in a structured interview with surgical residents, did identify a lack of surgical EBM resources and information as a significant barrier. 15 The respondents did suggest that journal clubs were frequently used as an opportunity to discuss best evidence in a clinically relevant arena, and it appeared that there was a correlation with consistently emphasizing critical appraisal skills in this venue and a feeling of appropriate evaluation of EBM skills throughout residency. The results of this survey do suggest that residents and faculty both use real-time clinical experiences to emphasize and discuss best evidence concepts, an important component of any EBM curricula in training.…”

Section: Discussionmentioning

confidence: 99%

“…The barriers that were identified by the residents, such as time constraints and a perceived lack of appropriate educators, are very similar to previous reports in other residency programs in both the United States and Canada. 15,17 Beyond journal clubs, online module activities or block rotations can be effective, efficient techniques for teaching the basics of EBM. It would appear appropriate for programs to review their own experience and access to such freestanding curricula available at their centres in order to reinforce these content components of EBM.…”

Section: Discussionmentioning

confidence: 99%

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The status of evidence-based medicine education in urology residency

Roth

2013

CUAJ

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Introduction: Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of the current best evidence in decision-making for the care of patients. Teaching best evidence practice in residency should include both formal or freestanding content, as well as integration into clinical scenarios and patient care. We sought to assess the attitudes, experience and knowledge of EBM in urology residency training across Canada.Methods: An anonymous, cross-sectional, self-report questionnaire was completed by a convenience sample of 29 residents, including all chief urology residents in English-speaking programs across Canada. The survey included both open-ended and closedended questions designed to assess familiarity and attitudes towards EBM and potential barriers to developing EBM skills in a surgical training program. Questions were formatted to determine the understanding of statistical and analytical concepts, as well as familiarity of available EBM resources. Descriptive and correlative statistics were used to analyze the responses. Results:The response rate was 100%. An overwhelming majority of residents felt that EBM is an important component of the urology residency and journal club was the most common vehicle for discussing best evidence concepts. However, there was significant variation in the presence of freestanding, formal curricula across programs, with only 28% of residents signifying that they received any formal training in their program. The apparent level of understanding of important EBM terminology and resources appears to be limited. The most frequently stated barriers to incorporating EBM curricula into urology training were time constraints and a perceived lack of expert educators. Conclusion:This self-report survey of urology chief residents identified the overwhelming acceptance of the importance of EBM in their training. Although best evidence practices appears to be addressed in journal clubs and in real-life clinical experiences, the obvious lack of familiarity and understanding of EBM content and resources would suggest a need for redoubling efforts to ensure appropriate exposure and instruction in our training programs.

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“…Interestingly, in one Canadian study included in this review, several surgical residents reported a fear of repercussion from staff surgeons when confronting them with new evidence. 3 (There were no urology residents in this study! )…”

mentioning

confidence: 98%