Is evidence-based medicine a mirage in resource-constraint settings? A survey among resident doctors in selected teaching hospitals in Nigeria

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Bello S1, Ajayi D1, Bamgboye E1, Mpama E2
1College of Medicine, University of Ibadan, 2College of Health Sciences, University of Calabar

Background: The adoption of evidence base medicine (EBM) in clinical practice has demonstrated effectiveness in reducing mortality, shortens hospital stay and the overall costs of patient care. Despite the strides that EBM has achieved globally, the adoption in some parts of the world is at best rudimentary.

Objective: The study aimed to assess the self-rated knowledge of, attitude towards, practice (KAP) of, and barriers militating against EBM among resident doctors in Nigeria.

Methods: This was a cross-sectional web-based survey among 238 resident doctors in four selected teaching hospitals in southern Nigeria. Survey questionnaire contained items assessing the KAP of EBM, familiarity with and understanding of key EBM terms, the use of EBM in decision making, barriers militating against EBM and perceived ways to improve EBM adoption. Proportions and summary statistics were reported for the distribution of survey items.

Results: Mean number of years in clinical practice was 9.3 ± 4.5 years. Respondents were uniformly distributed in major clinical specialties. The majority (70.5%) were senior registrar. Respondents’ understanding of EBM components included; current best clinical evidence (98.3%), clinical expertise (65.5%) and patients’ choices (36.6%). Self-rated familiarity with EBM terms was high while perceived understanding of the terms was lower. The least understood concept was heterogeneity (20.6%). The attitude towards EBM was generally positive. Only about half (53.6%) used medical bibliographic databases within the last six months prior to survey. Barriers against EBM included lack of time (47.1%) and lack of requisite skills (32.4%). Suggestions to improve EBM adoption included training (58.1%), provision of free Wi-Fi, and free access to bibliographic databases (25.2%) and increased political will (23.1%).

Conclusion: A further understanding of the EBM concept, provision of enabling infrastructure, regular clinical audit and advocacy to hospital management and clinical consultants, may improve the level of adoption of EBM.