Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence‐Based Practice

Abstract

In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.

Trends in First‐Year Dental Students’ Information Technology Knowledge and Use: Results from a U.S. Dental School in 2009, 2012, and 2017

“…In general, practicing dentists’ attitudes about evidence‐based dental practice and the use of clinical guidelines have been found to be positive 16 , 17 . However, there are significant barriers to the use of EBD in daily practice, including cognitive biases to which all humans are susceptible 18 , 19 . Dentists must be able to successfully convey accurate information to their patients, especially when inaccurate health information is only a click away.…”

“…Both the Federal Drug Administration and the National Institutes of Health warn the public about the multitude of inaccuracies concerning health information on the Internet 20 . Coleman et al made several suggestions to dental educators to help students develop an EBD mindset and critical appraisal skills that extend beyond graduation 18 …”

How do dental faculty members relate to Evidence-Based Dentistry?

“…Schneider et al (2018) 12 , having identified limitations of dentists from the Brazilian Family Health Strategy to develop EBD, suggests that the knowledge, practice, and attitudes regarding EBD should be developed during undergraduate studies. Individual limitations have represented barriers to the effective implementation of EBD, including the lack of knowledge on clinical epidemiology and limited skills for searching information 7,16,17 .…”

“Perspectives” on Dental Education

“…This month's JDE provides two examples of Perspectives articles that satisfy these principles, though in different ways. In “Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence‐Based Practice,” Coleman et al use research from the disciplines of medicine, psychology, and behavioral economics to explore how difficult it is to use evidence‐based dentistry (EBD) principles 2 . Although agreeing that EBD is a worthy goal, they explain how internal biases (hindsight, optimism, survivor, and blind‐spot biases), as well as external biases (publication and corporate biases and lack of transparency), impact implementation of EBD.…”