Perception and Attitude of Residents in Using Evidence-Based Medicine

Introduction

In the late 20th century, scientists sought concrete evidence to apply in diagnosing and treating diseases and surgical interventions. Therefore, Evidence-Based Medicine (EBM) was proposed as a way to search, critically evaluate, and use research results in medical practice. Evidence-based medicine means the conscious, explicit, and wise use of the best evidence in the decision-making process to provide patient care services. Although evidence-based medicine seems to be the standard gold and its use is growing, in reality, it is still not widely used. In this regard, developed countries have been trying to close the gap between research and medical practice by using evidence-based medicine for years. For example, the American Institute of Medicine stated that many medical errors are due to practitioners' lack of knowledge about the best medical methods. It can be reduced to a large extent if they use a systematic search method to get the best evidence. In addition, recent studies have been done in Iran showed that evidence-based practice had received attention in various fields of medicine. Despite this, medical practitioners' awareness, attitude, and performance of evidence-based medicine were low resulted from a lack of facilities, time, and proficiency in English. However, since resident physicians play an essential role in teaching medical students and are crucial clinical decision-makers in teaching hospitals, their ability to use the evidence-based medicine has effectively reduced medical errors and improved clinical decisions. Therefore, the present study was designed to assess residents' attitudes and perceptions of using evidence-based medicine through self-declaration.

This research was an applied and descriptive-cross-sectional study. The study population consisted of all medical and dental residents studying at Ahvaz Jundishapur University of Medical Sciences in 2020. Two hundred and nine residents participated in the study by completing the questionnaire. Then data were collected through the census method, and sampling was not done. However, the unavailable residents were excluded from the study due to the outbreak of Covid-19 during data collection. The research instrument was a questionnaire with validity and reliability of 0.79 and 0.7, respectively. The questionnaire consisted of 4 parts, the first part of which included 13 questions regarding the level of familiarity of the residents with evidence-based medicine, the level of access to the Internet, and the resources used to update information. In the second and third parts of the questionnaire, questions were asked for self-assessment of the attitude and skill toward evidence-based medicine. In addition, the Likert scale was used to measure the responses. The questionnaires were distributed among the participants in face-to-face contact. A deadline of 7 days was considered to respond to the questionnaire. The participants' identification data were not collected due to protect privacy. Also, the obtained data were analyzed in SPSS version 21 using descriptive analysis, including frequency tables, mean and standard deviation, and analytic statistics.

The results showed that 54.5% of the respondents were male, and 45.5% were female, and the average age was 32.31 ± 4.246, with an alpha of 0.05. In addition, 42.1% of the participants passed at least a course in evidence-based medicine, and 65.5% were familiar with it. Also, most of them knew the PubMed database (89%), and their familiarity with the Bandolier (3.3%), Dare, and DOAJ (zero percent) databases were minimal. Moreover, the participants used printed books as the first and most important source of information (41.5%). According to 40% of the participants, lack of knowledge of using the sites was the most important reason for not using Internet-based information sources. Furthermore, 54.8% of the participants agreed that evidence-based medicine is a feasible method for the daily care of patients, and 52.9% of them stated that its everyday use could be helpful. Also, the results of the study indicated that the participants' attitude regarding their performance in evidence-based medicine about their skill in evaluating the quality of a clinical trial study with 7.7% was at the highest level.On the other hand, the lowest level of their skill was related to the best article selected from among several articles, with 3.3%. Even though evidence-based medicine is taught in many major universities around the world and is used in medical practices, the results of this study, which were in agreement with other studies, showed that only about half of the residents were familiar with it, or they passed a training related course. Besides, the results of this study showed that although evidence-based medicine was valuable and important from the participants' point of view, they were not using evidence-based databases as the primary source to get information. In this regard, several studies have also reported similar findings. A limitation of this study was the impossibility of participation all the residents due to the outbreak of COVID-19. Therefore, the researchers had to involve as many residents as were available. However, a positive point of this research was the study on residents from various medical and dental fields.

In general, the results showed moderate knowledge and skills in using evidence-based medicine databases among residents. Also, PubMed was a popular database among the residents. As related studies have suggested, although evidence-based medicine is part of the academic curriculum, to increase residents' knowledge and skill, therefore, it seems necessary to plan an educational program or workshop.