Examining aptitude and barriers to Evidence Based Medicine among trainees at an ACGME-I accredited program

Abstract

Background Evidence-based medicine (EBM) promotes critical thinking and produces better patients’ outcome. Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East. Methods Clinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Trainees’ various backgrounds in medical education hypothesize different levels and experiences of EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, we surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees’ attitudes and perceptions of EBM. Trainees were also asked to complete the ACE tool to assess their knowledge proficiency regarding different elements of EBM. The results from the two were analyzed. Results The average score on the ACE tool among the participants was around 9 out of 15. Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. Participants also reported reasonable capabilities of doing EBM and favorable atmosphere at work for EBM implementation. Lack of knowledge, resources and time were the most reported barriers for doing EBM. Conclusions Earlier adoption of EBM education and practices leads to increased competence and it should be taught and evaluated in the undergraduate and GME programs. This's especially true since it's known that EBM practices lead to better patient outcomes. In a setting where matriculating clinicians arrive from heterogeneous educational backgrounds and EBM experiences, it is important to assess and continuously implement EBM training.