Teaching and learning evidence-based medicine: cross-sectional survey investigating knowledge and attitudes of teachers and learners in primary and secondary care

Abstract

Evidence-based medicine (EBM) is an important component of quality healthcare and a key part of the curriculum for doctors in training. There have been no previous studies comparing attitudes and knowledge of doctors in primary and secondary care towards EBM practice and teaching and this study sets out to investigate this area. We asked participants, a stratified sample of general practitioners, hospital consultants, GP registrars and junior hospital doctors in Leicester, Northamptonshire and Rutland, UK, to complete a self-administered survey questionnaire and written knowledge test which provided ‘positive to evidence based practice’ (PEP) attitude scores and Manchester Short EBM Questionnaire Education for Primary Care (2007) 18: 45–57 # 2007 Radcliffe Publishing Limited WHAT IS ALREADY KNOWN IN THIS AREA. There is little evidence on the relationship between attitudes and knowledge in relation to evidence-based medicine (EBM) in family doctors, consultants and doctors intraining. WHAT THIS WORK ADDS. This study showed that, although general practitioners and general practitioner trainers were significantly less positive in attitude to EBM compared to GP registrars, junior hospital doctors and consultant respondents, they had significantly higher knowledge scores. This study demonstrated that the attitude (PEP) score and knowledge questionnaire(MANSEBMQ) have high reliability but require further research to demonstrate validity. SUGGESTIONS FOR FURTHER RESEARCH. There remain opportunities for refinement of the MANSEBMQ, validation against existing tools and further application in a larger study, including assessment of EBM knowledge and skills, before and after an educational process, involving students in clinically relevant and integrated EBM learning. Keywords: attitudes, evidence-based practice, general practice registrars, general practitioners, hospital doctors, primary care, secondary care(MANSEBMQ) knowledge scores of participants. The response rate was low which may have led to volunteer bias but there were sufficient responses to explore attitude scores and knowledge scores. Attitude(PEP) scores were highest in hospital consultants, intermediate in doctors in training and lowest in general practitioner (GP)respondents (mean score 71.7 vs 70.5 vs 67.2; P = 0.006). PEP scores were also highest in respondents with higher degrees (MD, PhD, MSc), intermediate in those with higher professional qualifications (MRCP, FRCS, MRCGP or equivalent) and lowest in those with none of these (mean score 72.9 vs 70.6 vs 67.2; P = 0.005). PEP scores were significantly higher(P = 0.002) in respondents who taught EBM (mean score 71.7, 95% CI 70.3 to 73.2, n=109, missing=5) compared with those who did not (mean score 68.6, 95% CI 67.3 to 69.9, n = 105, missing = 12) and in respondents with research experience (P < 0.001), research training (P < 0.001) and training in EBM (P = 0.001). There was a positive correlation between PEP score and MANSEBMQ score (P = 0.013). In contrast, and paradoxically opposite to the pattern of attitudes, knowledge scores were highest in GPs, intermediate in junior hospital doctors and lowest in consultant respondents (mean score 63.5 vs 61.9 vs 54.5, P=0.005). Although GPs and GP trainers were significantly less positive in attitude to EBM compared to GP registrars, junior hospital doctors and consultant respondents, they had significantly higher knowledge scores. This study demonstrated that the attitude(PEP) score and knowledge questionnaire (MANSEBMQ) have good reliability but require further research to demonstrate validity