Article type
Year
Abstract
Background: Medical practitioners must negotiate among numerous, often-conflicting sources of authority in day-to-day clinical decision making: quantitative evidence derived from scientifically conducted research, expert opinion, their own experience (derived from routine clinical observations), local practice standards, institutional mandates, and patient values and preferences. Each of these sources of authority play a role in at least one model of rationality.1-3 For example, the classic and normative models of rationality privilege decision-making based on quantitative data resulting from controlled, replicable studies and Bayesian calculation of probabilities.1,2 In contrast, the Brownian model privileges socially mediated expert judgment,1 while a Habermasian model privileges unconstrained and equal input from all stakeholders, so that integrating patient values and preferences becomes necessary to rational decision making.3 While a number of surveys have evaluated clinician knowledge of and/or attitudes towards evidence-based medicine (EBM), none has been explicitly designed to clarify and describe clinician commitments to the various sources of authority entailed in these not wholly compatible categories of evidence. Objectives: The objective of this project was to design and validate an instrument to collect data about medical practitioners attitudes toward and understanding of the principles of evidence-based medicine (EBM) that is deliverable in a variety of health-delivery contexts via the Internet.
Methods: We reviewed survey instruments published in the biomedical literature that were designed to measure clinician attitudes toward and/or knowledge of EBM.4-15 We solicited copies of their instrument from these investigators when it was not included in their publication. From these instruments, we selected questions that addressed clinician commitments to competing sources of authority as well as social, logistic, and institutional incentives/barriers to the implementation of EBM. Further questions were designed and pilot tested if previously published questions did not adequately address issues of concern. We designed questions to elicit both qualitative and quantitative data (with deliberate redundancy to permit internal validity checking). Internal consistency was also assessed using the method described by Trelle.16 Several rounds of pilot testing were conducted to ensure the comprehensibility and face and content validity of the questions.
An English version of the survey is being administered in the midwestern United States (see Freeman et al. abstract). English and Russian versions of the survey will be offered in 28 countries that were formerly members of the USSR (see Storey et al abstract). We anticipate that a customized version of the survey will also be offered in Australia in the autumn of 2004.
The Internet was chosen as the delivery medium for the survey because of its ubiquitous presence in clinical and educational practice. Realistically, the practice of EBM requires access to a Web browser, so we chose the internet to serve as the common platform on which to offer the survey. Foresight during the survey design allows for language and geographical differences in all three versions of the survey. We have addressed the ethical, logistic, and technological challenges of online survey delivery, including subject consent, data privacy, and confidentiality.
Acknowledgments: The authors wish to gratefully acknowledge the assistance of investigators who supplied copies of their survey instruments. We would also like to acknowledge the financial support of the University of Wisconsin Eau Claire.
Methods: We reviewed survey instruments published in the biomedical literature that were designed to measure clinician attitudes toward and/or knowledge of EBM.4-15 We solicited copies of their instrument from these investigators when it was not included in their publication. From these instruments, we selected questions that addressed clinician commitments to competing sources of authority as well as social, logistic, and institutional incentives/barriers to the implementation of EBM. Further questions were designed and pilot tested if previously published questions did not adequately address issues of concern. We designed questions to elicit both qualitative and quantitative data (with deliberate redundancy to permit internal validity checking). Internal consistency was also assessed using the method described by Trelle.16 Several rounds of pilot testing were conducted to ensure the comprehensibility and face and content validity of the questions.
An English version of the survey is being administered in the midwestern United States (see Freeman et al. abstract). English and Russian versions of the survey will be offered in 28 countries that were formerly members of the USSR (see Storey et al abstract). We anticipate that a customized version of the survey will also be offered in Australia in the autumn of 2004.
The Internet was chosen as the delivery medium for the survey because of its ubiquitous presence in clinical and educational practice. Realistically, the practice of EBM requires access to a Web browser, so we chose the internet to serve as the common platform on which to offer the survey. Foresight during the survey design allows for language and geographical differences in all three versions of the survey. We have addressed the ethical, logistic, and technological challenges of online survey delivery, including subject consent, data privacy, and confidentiality.
Acknowledgments: The authors wish to gratefully acknowledge the assistance of investigators who supplied copies of their survey instruments. We would also like to acknowledge the financial support of the University of Wisconsin Eau Claire.