Evidence based practice in clinical physiotherapy education: a qualitative interpretive description

Abstract

BackgroundHealth care undergraduate students are expected to practice evidence-based after they graduate. Previous research indicates that students face several problems with transferring evidence-based practice to real patient situations. Few studies have explored reasons for this. The aim of this study was to explore beliefs, experiences and attitudes related to third year students’ use of evidence-based practice in clinical physiotherapy education among students, clinical instructors and visiting teachers.MethodsIn total, six focus group interviews were conducted: three with 16 students, two with nine clinical instructors and one with four visiting teachers. In addition, one individual interview and one interview in a pair were conducted with clinical instructors. Interviewing three different participant-categories ensured comparative analysis and enabled us to exploit differences in perspectives and interactions. Interpretive description guided this process.ResultsFour integrative themes emerged from the analysis: “attempt to apply evidence-based practice”, “novices in clinical practice”, “prioritize practice experience over evidence-based practice” and “lack role models in evidence-based practice”. Students tried to search for research evidence and to apply this knowledge during clinical placements; a behaviour that indicated a positive attitude towards evidence-based practice. At the same time, students were novices and required basic background information more than research information. As novices they tended to lean on their clinical instructors, and were more eager to gain practical experience than practicing evidence-based; a behaviour that clinical instructors and visiting teachers often supported. Students noticed a lack of an EBP culture. Both students and clinical instructors perceived a need for role models in evidence-based practice.ConclusionsClinical instructors are in a position to influence students during clinical education, and thus, important potential role models in evidence-based practice. Actions from academic and clinical settings are needed to improve competence in evidence-based practice among clinical instructors, and future research is needed to investigate the effect of such efforts on students’ behaviour.

Self-assessment of final-year undergraduate physiotherapy students’ literature-searching behaviour, self-perceived knowledge of their own critical appraisal skills and evidence-based practice beliefs

“…This was the same for another SA study that also found students had access to the internet on campus. [9] Contrary to the literature [3] that indicated that undergraduate students found it difficult to determine if research evidence was valid and applicable, the students in the current study showed some confidence in assessing research evidence. However, the insecurity of students transitioning to qualified practitioners who will engage in evidence-based practice was evident in their statements that they only felt slightly confident in literature appraisal and wanted more training in evidence-based practice.…”

“…[3,6] One study found that although research methods and statistics had been essential components of a Bachelor's programme at a Norwegian university for a number of years, students continued to struggle with finding and using relevant and valid information such as research evidence. [3] The students received little, if any, practical guidance in clinical settings on how to apply research evidence to real patient management. In the same study, [3] the physiotherapy students did attempt evidence-based practice in the clinical setting.…”

“…[10] This was also similar to the study in Norway where it was evident that although students value evidencebased practice and recognise it as a vital part of clinical practice, they continue to feel that they need more training in it. [3] Therefore, the need for more training in applying evidence-based practice is evident across disciplines.…”

“…[3] The students received little, if any, practical guidance in clinical settings on how to apply research evidence to real patient management. In the same study, [3] the physiotherapy students did attempt evidence-based practice in the clinical setting. In our study, the students were only exposed to the basic skills of research in the 3rd and 4th years of study; the literature states that research skills and the skills of searching, appraising and applying research evidence to individual patients should be taught early and applied as an essential part of learning during the entire curriculum.…”

“…[2] As evidence-based practice emerged and grew, healthcare professionals and new graduates were expected to use and be confident in applying evidencebased practice skills. [3] The Sicily Statement on evidence-based practice states that on graduation, healthcare professionals must have the skills to search for and appraise new knowledge and apply it to their practice, as well as begin an appreciation for life-long learning, to be able to adapt to changes throughout their careers. [4] According to the Sicily Statement, the evidence-based practice process consists of five steps: (i) translation of uncertainty to an answerable question; (ii) systematic retrieval of best evidence available; (iii) critical appraisal of evidence for validity, clinical relevance and applicability; (iv) application of results in practice; and (v) evaluation of performance.…”