Sources of knowledge in clinical practice and knowledge of evidence based medicine in postgraduate medical students and faculty members

Tags: Oral
Yousefi Nooraie R, Shakiba B, Mortaz Hejri S, Soroush A

Background: One of the considerable barriers to the dissemination of evidence based medicine in developing countries is the dominance of the experience based medicine debate that is the consequence of traditional approaches to medical education.

Objectives: To determine the most important knowledge sources that can influence clinical practice and to describe the attitude, knowledge and behaviors of postgraduate medical students and faculty members relative to the use of evidence in practice.

Methods: Faculty members, fellows and residents of a large teaching tertiary care hospital were asked to rate the importance of different resources in their daily clinical practice, the percentage of their practice that is based on the best current evidence (using visual analogue scale method) and their understanding of some common terms from evidence based medicine.

Results: A total of 250 of 320 recruited hospital staff returned the questionnaires (48 faculty members, 35 fellows and 167 residents), 36 of them refused to participate and the others were not accessible during the study period. The perceived percentage of clinical practice that was based on the best current evidence in faculty members, fellows and residents were 63.3+-20, 64.6+-20 and 58.2+-19.6 respectively. The most important resources in daily practice were English journals, text books and searching skills for faculty members, experience, text books and English journals for fellows and text books, experience and peers for residents. Regional journals and drug catalogues were the least important resources for all study groups. The percentage of respondents who felt that they understood the meaning of technical terms and used them in their daily practice is shown in the table 1. About 62.7% of residents did not know the meaning of "number needed to treat", 36.8% "confidence interval", 54.9% "confounding factor" and 44.6% "meta-analysis". The percentages for faculty members were 41.3%, 37%, 42.2% and 39.1%. See table below.

Conclusion: Medical education in developing countries is based on the traditional curricula that focus on the pathophysiological reasoning, personal observation and intuition and undervalue regional research which may be an important barrier to the development of evidence based medicine and would be tackled only by fundamental reforming in medical education.