Self-reported knowledge, attitudes, practices and barriers in use of evidence-based medicine among resident physicians in Kenya: a mixed methods study

Abstract

Background Evidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide safe and most cost-effective care. Postgraduate doctors are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine but very few studies have been done in Sub Saharan Africa. This study explored the self-reported knowledge, attitudes, practices and barriers of evidence-based practice among resident physicians in a tertiary teaching hospital. Methods A mixed methods cross-sectional study that used convergent parallel design was conducted. The quantitative arm was conducted among all residents enrolled in the Master of Medicine programme at Aga Khan University Hospital Nairobi (AKUHN). It included an online survey exploring self-reported knowledge, attitudes, practices and barriers of EBM among all residents. Simultaneously, semi-structured In-Depth Interviews were carried out among 18 purposefully selected residents in order to explore the same themes in more depth. Results One hundred and one residents (99%) responded to the survey. The mean scores for self-reported knowledge, attitude and practice of EBM among residents were 73.88, 66.96 and 63.19% respectively, which were generally higher than in comparable studies. There was a significant association between year of residency and practice of EBM. The most common barriers faced by residents were lack of time, lack of EBM skills and patients’ unawareness about EBM. From the qualitative study, residents demonstrated good knowledge and support of EBM but practice remained relatively poor. Barriers to EBM were characterized by lack of motivation, time, skills and resources, patient overload and fear of challenging consultants. Conclusion There was good understanding and support of EBM among residents at AKUHN, though challenges were experienced in regards to practice of EBM because of lack of time and skills. Therefore resources should be allocated towards integrating EBM into undergraduate medical curricula to cultivate critical thinking skills at an early stage before transition into residency.

Knowledge, attitude, and practice of evidence-based medicine among resident physicians in hospitals of Syria: a cross-sectional study

“…Such results are consistent with the low levels of knowledge and attitude shown by the participants. Similar results shown by many studies conducted in other regions [ 26 ]. The limited practice of EBM could be the result of a range of obstacles such as a lack of time, a lack of sources published in the native language and insufficient skills required in evidence-based practice [ 27 ].…”

Teaching evidence-based medicine in Mexico: a systematic review of medical doctor curriculums at a national level

“…In Germany and the UK, scarce opportunities for acquiring basic research skills during undergraduate education have been reported 54. Our findings are consistent with observations from Europe, Africa, the Middle East and Latin America 48 55–58. In a survey of Latin American medical students, 67.4% reported not receiving adequate training in research and publication 58.…”

Knowledge, Attitude, and Practice towards Evidence-Based Medicine among Northern Saudi Primary Care Physicians: A Cross-Sectional Study

“…Our findings are consistent with a recent cross-sectional survey conducted in Croatia by Nejašmić D et al They explored that less than half of the family physicians considered the major EBM database (Medline—49.1% and Cochrane library—47.1%) useful for patient care [ 23 ]. Interestingly Unadkat, M.B et al 2021 reported a good understanding of EBM among their study respondents [ 24 ]. These striking dissimilarities were perhaps the result of the diversity of the responding doctors.…”

“…Similarly, EBM-related knowledge was significantly higher among doctors who received formal training for EBM [ 19 ]. A study conducted in Kenya by Unadkat et al reported that age is not a significant factor related to EBM knowledge [ 24 ]. The possible dissimilarities between the current study and this study could be the inclusion criteria of physicians.…”

“…Another recent survey by Unadkat MB et al reported a similar finding to the present research. Their survey’s most common barriers were lack of EBM knowledge and training and patient-related factors [ 24 ]. In another study, Li et al reported that focusing on the workplace and organizational context is essential for the implementation of evidence-based practice in an organization, including primary health centers.…”