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183]

86 Original article

An interventional study: impact of an evidence-based medicine

educational program on knowledge, attitude, and practice of
physicians in Benha University Hospitals
Ossama M. Wassefa, Mahmoud F. EL-Gendya, Abdelmoniem A. Y. Dawahb,
Raniyah H. M. Shakerc, Hala A. Abedd
a
Professor of Public Health and Community
Medicine, Faculty of Medicine, Benha
University, bProfessor and Head of Department
of Public Health and Community Medicine,
Faculty of Medicine, Benha University,
c
Assistant Professors of Public Health and
Community Medicine, Faculty of Medicine,
Benha University, dAssistant Lecturer of Public
Health and Community Medicine, Faculty of
Medicine, Benha University, Benha, Egypt
Correspondence to Hala A. Abed, Assistant
Lecturer of Public Health and Community
Medicine, Faculty of Medicine, Benha
University, Egypt; fax: +2133234316;
E-mail: halaabed20@gmail.com
Received 12 December 2015
Accepted 17 April 2016
Benha Medical Journal
2016, 33:86–94
Objective
The aim of the present study was to examine the changes in knowledge, attitude,
and practice of evidence-based medicine (EBM) among physicians.
Patients and methods
The present interventional study was conducted from December 2012 to December
2013 at Benha University Hospitals in the Qualibia governorate, Egypt. Data were
collected in three stages: first, by determining the physicians’ knowledge, attitude,
and practice toward EBM; second, by conducting an educational program to
increase awareness and improve attitude and practice of physicians toward
EBM; and, third, by determining their knowledge, attitude, and practice toward
EBM after the program. A total of 220 self-administrated questionnaires were
distributed to physicians in different specialties.
Findings
The response rate was 70.5% across different specialties. Overall, 73.2% of the
physicians had poor knowledge of EBM before the program, which decreased to
40.2% after the program. This change was statistically significant. Most of the
physicians had a high attitude score (92.3 and 97.3%) toward EBM before and after
the program, respectively. Poor percentage of physicians (before and after the
program) reported attending any courses in EBM (18.2 and 24.5%). More than 60%
physicians (before and after the program) used the Internet to inform their practice.
The most prevalent barrier against the use of EBM among physicians was the
attitude of colleagues (94.6% before and 89% after the program).
Conclusion
After the educational program, knowledge on evidence-based practice improved
markedly. Physicians’ attitude towards EBM was positive before and after the
program. Changes in practice were small, and were based on the frequency of
searching and appraisal activities.

Keywords:
attitude, evidence-based medicine, knowledge, physicians, practice
Benha Med J 33:86–94
© 2017 Benha Medical Journal
2357-0016

practices of EBM. In a study conducted for general

Introduction
practitioners in England, respondents welcomed EBM
Evidence-based medicine (EBM) is the process of
and agreed that its practice would improve patient care
identifying and assessing the best available scientific
[4].
evidence and integrating this evidence with the
clinician’s judgment and the patient’s values to make
In another study in Jordan, 95% of the family
medical decisions [1].
physicians had positive attitudes toward EBM.
Knowledge of absolute risk and systematic review
Awareness of the latest scientific evidence and the
accounted for 29% of physicians. In addition, 9.9%
ability to critically appraise the literature and assess
of the studied sample reported using EBM in 75–100%
its applicability has been identified as integral to the
of their clinical practices [5].
practice of EBM [2].

There are many advantages of practicing EBM. Those

patients who receive evidence-based therapies have
better outcomes than do those who do not [3].
Many studies have been conducted all over the
world to evaluate the awareness, attitudes, and
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© 2017 Benha Medical Journal | Published by Wolters Kluwer - Medknow DOI: 10.4103/1110-208X.201283
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Impact of EBM education on KAP of physicians Wassef et al.
In Egypt, a study conducted in Ain Shams University
to determine the knowledge, attitudes, and practices of
EBM among residents revealed that, the highest
awareness of EBM resources (73.6%) was reported
for PubMed, with poor awareness of other resources,
and that most of the residents (98%) were aware of
some EBM-related technical terms. The majority of
the residents welcomed EBM. Lack of personal time
was reported by 76.8% as a barrier against practicing
EBM [6].
Few studies have been carried out in Egypt to assess the
awareness of physicians toward EBM. Most studies
assessing the impact of teaching EBM have focused on
medical students and residents, rather than on
practicing physicians. Our aim was to establish an
educational program on EBM and to measure the
change in physician’s knowledge and attitudes
toward EBM, their skills to practice it, and barriers
to move from opinion-based to evidence-based
practices. The results would help to establish the
educational requirements necessary for a greater use
of EBM in medicine. Benha Faculty of Medicine
Hospitals was chosen as the site of the study as it is
the only university hospital present in the Al Qualibia
governorate, Egypt.
Aim of the work
Objective
The aim of the present study was to examine the change
in knowledge, attitude, and practice of EBM among
physicians (residents, demonstrators, and assistant
lecturers) working at Benha University Hospitals after
conducting an educational program.
Patients and methods
This interventional study was conducted from
December 2012 to December 2013.
Study type
This was an interventional study 1++, which measured
the change in knowledge, attitude, and practice of
participants before and after the medical educational
program.
Study setting
The study was carried out at Benha University
Hospitals. The educational hospitals of Benha
Faculty of Medicine have a capacity of 940 beds,
distributed among all specialties, serving about 160
000 patients annually at its outpatient clinics and
inpatient departments. The following hospitals were
87
included: Internal Medicine Hospital and Surgery
Hospital.
Participants
The study was conducted on those physicians
(residents, demonstrators, and assistant lecturers)
working at Benha University Hospitals who accepted
to participate in the study.
Sample size
Sample size was estimated to be 220 physicians using
the Epi info statistical package (EPI info version 6,
CDC).
The calculation of sample size based on this concept
requires the knowledge of the following:
(1) Total number of physicians (residents, demo-
nstrators, and assistant lecturers) in Benha
University Hospitals was 312 [7].
(2) The sample size at 95% confidence interval and
80% power would be as follows:
(a) For knowledge (60.3 ± 5%), a sample size of at
least 169 is required.
(b) For positive attitudes (95 ± 5%), a sample size
of at least 59 is required.
For practices (9.9 ± 5%), a sample size of at least 95 is
required [5]. Therefore, based on 60.3 ± 5% as the
percentage of EBM knowledge and after adjusting
for a 20% dropout, a sample size of 220 physicians
was suggested.
Data collection and study tools
Collection of data was conducted in three stages:
(1) Stage 1:
The data were collected from physicians using ready,
self-administrated questionnaire guided by researcher’s
instructions to determine their knowledge, attitude,
and practice toward EBM. The questionnaire was
modified from the study of McColl et al. [8].
The questionnaire consisted of five items:
(a) Cover letter, sociodemographic data, knowledge
assessment (physicians’ awareness of extracting
journals and review publications and their
understanding of technical terms used in EBM),
questions to describe attitude of physicians towards
EBM, questions to describe practicing of EBM,
methods of moving from opinion-based medicine to
EBM, methods the physicians seek to solve clinical
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88 Benha Medical Journal, Vol. 33 No. 2, July-December 2016
problems in their daily practice, and perceived major
barriers to practicing EBM in medical practice from
their point of view.
(b) Knowledge score:
(i) It consisted of 15 items (eight items to
determine physicians’ awareness of journal
sites and seven items to reveal awareness
of statistical terms used in scientific
articles).
(ii) The eight items had a four-response format:
(0) unaware, (1) aware but not used, (2) read,
and (3) used to help in decision-making. The
seven items had a four-response format: (0) It
would not be helpful to me to understand, (1)
do not understand but would like to, (2) some
understanding, and (3) understand and could
explain to others. Subscale scores ranging
from 0 to 3 were achieved by summing the
items in each subscale and then calculating the
score percentage. Knowledge scores were
classified as high (>60%), fair (40–60%),
and poor knowledge (<40%).
(c) The attitude score: It consisted of three items, with a
five-response format (Likert scale) from (1)
strongly unwelcoming to (5) strongly wel-
coming. Subscale scores ranging from 1 to 5
were achieved by summing the items in each
subscale and then calculating the score
percentage. Attitude scores were classified as
high (>60%), fair (40–60%), and poor attitude
(<40%).
(d) Stage 2 (medical educational program):
(a) The objectives of the medical educational
program were increasing awareness and
improving the attitude of physicians, and
enhancing the practice of EBM.
(b) The message of the program was to
demonstrate the definition and importance
of EBM, reason for training in EBM
methodology and skills, and to find the best
evidence and steps to practice EBM.
Methods: The message was formulated to cover all the
information about EBM by using appropriate methods
such as giving lectures and conducting group
discussions. Handouts containing the topics of EBM
were given to the participants. Projected materials were
used to underline the most important points in the talk.
Two workshops were held for physicians in
coordination with the training department in Benha
University Hospitals.
Place: The program was conducted at a comfortable
place, with the size of the group ranging from five to 20
participants. The total number of sessions was about
four/week, with about 20 physicians/week (about 80/
month) for 2 months.
Time: Each session took 50 min.
Stage 3:
It involved measuring the change in physician’s EBM
knowledge, attitude, and practice after the medical
education program, using the questionnaire used in
phase 1. A total of 220 physicians completed the
questionnaire. The incomplete ones were discarded
from the analysis.
Ethical aspect and administrative approach
Approval from the Ethical Committee of Benha
Faculty of Medicine and from the heads of different
hospitals was obtained before starting the study. In
addition, all the physicians signed an informed consent
before participation in the study.
Statistics
A pilot study was conducted to test the questionnaire
and evaluate the interviewer performance. Ten
individuals included in the pilot study were assistant
lecturers in different specialties (surgery, internal
medicine, and pediatric).
Stage 1 took 2 months, the educational program took
another 2 months, and the third stage was conducted 4
months after the application of the educational
program. The collected data were processed and
analyzed using the SPSS program version 16 (SPSS;
Version 16.0 for Windows, SPSS Inc., Chicago, IL).
The appropriate tests of significance were applied
based on a P value of less than or equal to 0.05. The
accuracy and uniformity of the collected data was
assured by checking the completed questionnaires.
Results
For items with a four-point Likert scale, categories
were collapsed into two categories: unaware and aware.
Category aware included ‘Aware but not used’, ‘read’,
and ‘used to help in decision-making’. Categories ‘Not
helpful to understand’ and ‘Don’t understand but
would Like’ were combined; moreover, categories
‘Some understanding’ and ‘Understand and could
explain to others’ were combined, so that the
response fell into one of the two categories: don’t
understand and understand. For items with a five-
point Likert scale, categories were collapsed into
three categories. ‘Unwelcoming’ and ‘strongly
unwelcoming’ categories were combined as were
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Impact of EBM education on KAP of physicians Wassef et al. 89

‘welcoming’ and ‘strongly welcoming’ so that the Table 2 reveals a statistically significant difference
response fell in one of the three categories: between knowledge and attitude scores after and
unwelcoming, neutral, and welcoming. before the educational program.

Table 1 shows that nearly half (49.1%) of the Table 3 shows that nearly three-fourth of the
respondents were males, with a mean age of 28.8 ± participants had poor knowledge (73.2%) about EBM
2.6 years. In all, 51% were assistant lecturers and only before the program, which decreased to 40.2% after the
14.5% reported currently studying fellowships. The program. This change was statistically significant.
mean years since graduation was 6.18 ± 2.87 years. In
addition, it revealed that internal medicine residents Table 4 reveals that most of the physicians had a high
account for 69%, followed by surgery residents (31%). attitude score (92.3 and 97.3%) toward EBM before
and after the program, respectively, with statistically
Table 1 Demographic characteristics of the participants
significant differences.
n = 220 [n (%)]
Sex Table 5 shows that there were statistically significant
Male 108 (49.1)
correlations between age of physicians, years since
Female 112 (50.9)
graduation, and knowledge score before and
Grade
Residents 76 (34.1)
after the program. Moreover, statistically significant
Demonstrators 32 (14.5) correlation was observed between years since
Assistant lecturers 112 (51.4) graduation and attitude score before the program.
Specialty The correlation between age and attitude score
Internal medicine departments 152 (69) before and after the program was statistically signi-
Surgical departments 68 (31) ficant.
Fellowship
Yes 32 (14.5)
Tables 6 and 7 show that poor percentage of physicians
No 188 (85.5)
Qualification
(before and after the program) reported attending
MRCS 8 (3.6) courses in EBM (18.2 and 24.5%) and critical
Infection control diploma 4 (1.8) appraisal (10 and 25.9%), respectively.
Diploma of International Council of 4 (1.8)
Ophthalmology In addition, the tables show that more than 50% of the
No 204 (92.7)
physicians believed that their percentage of EBM
Age
practice exceeded 50% before and after the program.
Mean ± SD 28.8 ± 2.6
Range 24–35
Years since graduation Tables 8 and 9 show that, most of the physicians had
Mean ± SD 6.18 ± 2.87 Internet access before and after the program (95.5 and
Range 1–12 97.3%, respectively). More than 60% (before and after
the program) used this search to inform their practice.
Table 2 Comparison between knowledge and attitude scores,
before and after the program Table 10 shows that there was a general agreement
Variables Preprogram Postprogram Wilcoxon P about the educational methods to be used to move
(mean ± SD) (mean ± SD) signed value
toward EBM practices with the highest percentage
ranks test
(83.2 and 88.2%) for EBM integration in the
Knowledge 31.17 ± 12.99 43.39 ± 17.28 7.856 0.000
score
undergraduate course, before and after program,
Attitude 79.33 ± 9.83 82.58 ± 9.37 3.306 0.001 respectively, with statistically significant results for
score EBM workshops and other educational methods of

Significant P value. EBM.

Table 3 Comparison between knowledge score before and after the program
Knowledge Preprogram [n (%)] Postprogram [n (%)] Total [n (%)] χ2 P value
Poor 161 (73.2) 89 (40.5 250 (56.8) 61.53 0.001
Fair 55 (25.0) 93 (42.3) 148 (33.6)
High 4 (1.8) 38 (17.3) 42 (9.5)
Total 220 (100) 220 (100) 440 (100)

Significant P value.
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90 Benha Medical Journal, Vol. 33 No. 2, July-December 2016

Table 4 Comparison between attitude scores before and after the program
Attitude Preprogram [n (%)] Postprogram [n (%)] Total [n (%)] χ2 P value
Fair 17 (7.7) 6 (2.7) 23 (5.2) 10.04 0.03
High 203 (92.3) 214 (97.3) 417 (94.8)
Total 220 (100) 220 (100) 440 (100)

Significant P value.

Table 5 Spearman’s correlation between age of physicians, years since graduation, and knowledge and attitude scores
Preprogram Postprogram
Knowledge score Attitude score Knowledge score Attitude score
Years since graduations
rs 0.467 0.156 0.336 0.088
Significance 0.000 0.029 0.000 0.220
Age
rs 0.575 0.342 0.280 0.144
Significance 0.000 0.000 0.000 0.033

significant results.

Table 6 Practicing of evidence-based medicine among physicians before and after the program
Practice of EBM Preprogram (n = 220) [n (%)] Postprogram (n = 220) [n (%)] χ 2-Test P value
Attendance of EBM course
Yes 40 (18.2) 54 (24.5) 2.7 >0.05
No 180 (81.8) 166 (75.5)
Training course in critical appraisal
Yes 22 (10.0) 32 (14.5) 2.11 >0.05
No 198 (90.0) 188 (85.5)
EBM, evidence-based medicine.

Table 7 Percentage of practice of evidence-based medicine among physicians before and after the program
Preprogram (n = 62) [n (%)] Postprogram (n = 86) [n (%)] χ 2-Test P value
Evidence-based practice percentage
0–50% 24 (38.7) 37 (43.1) 0.277 >0.05
>50% 38 (61.3) 49 (56.9)

Table 8 Access of physicians to Internet before and after the program

Practice of EBM Preprogram (n = 220) [n (%)] Postprogram (n = 220) [n (%)] χ 2-Test P value
Access to Internet
Yes 210 (95.5) 214 (97.3) 1.038 >0.05
No 10 (4.5) 6 (2.7)
EBM, evidence-based medicine.

Table 9 Accessing Internet before and after the program

Practice of EBM Preprogram (n = 210) [n (%)] Postprogram (n = 213) [n (%)] χ 2-Test P value
Using access to make influence
Yes 145 (69.1) 155 (72.9) 0.76 >0.05
No 65 (30.9) 58 (27.1)
Time of last search (months)
Mean ± SD 1.34 ± 0.87 1.06 ± 1.05
Reading any medical journal
Yes 173 (82.4) 184 (86.4) 4.6 >0.05
No 47 (17.6) 29 (13.6)
EBM, evidence-based medicine. Significant P value.

Table 11 shows that, verbal consultation from senior before and 75% after the program. Those methods
staff was 68.6% before and 79.7% after the program; were the commonest methods used by physicians to
reading textbooks and handbooks accounted for 68.6% solve clinical problems during patient management.
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Impact of EBM education on KAP of physicians Wassef et al. 91

Table 10 Physicians’ opinions on educational methods to move toward evidence-based medicine practice before and after the
educational program
Educational methods Preprogram (n = 220) Postprogram (n = 220) χ 2-Test P value
[n (%)] [n (%)]
EBM integration in undergraduate course
Yes 183 (83.2) 194 (88.2) 2.24 >0.05
No 37 (16.8) 26 (11.8)
Workshops
Yes 148 (67.3) 168 (76.4) 4.49 >0.05
No 72 (32.7) 52 (23.6)
Case review held in each department
Yes 148 (67.3) 166 (75.5) 3.603 >0.05
No 72 (32.7) 54 (24.5)
Other methods
Yes (exams, conference, evidence-based 3 (1.4) 19 (8.6) 10.77 0.001
guidelines and scholarships)
No 217 (98.6) 201 (91.4)

EBM, evidence-based medicine. Significant P value.

Table 11 Sources of information used by physicians when facing clinical problems, before and after the educational program
Sources of information Preprogram (n = 220) [n (%)] Postprogram (n = 220) [n (%)] χ 2-Test P value
Solving problem with basic sciences
Yes 139 (63.2) 157 (71.4) 3.35 >0.05
No 81 (36.8) 63 (28.6)
Verbal consultation
Yes 151 (68.6) 175 (79.6) 6.82 >0.001
No 69 (31.4) 45 (20.4)
Searching on Internet
Yes 65 (29.6) 82 (37.3) 2.95 >0.05
No 155 (70.4) 138 (62.7)
Textbooks and handbooks
Yes 151 (68.6) 165 (75.0) 2.2 >0.05
No 69 (31.4) 55 (25.0)

Significant P value.

The method used least was searching on the Internet
(29.6% before and 37.3% after the program).
Statistically significant difference was observed in
physician’s choice of verbal consultation to solve
clinical problems before and after the program.
Table 12 shows that the most prevalent barriers against
using EBM among physicians were attitudes of the
colleagues (94.6% before and 89% after the program),
no financial gains in practicing EBM (92.9% before
and 86.6% after the program), and insufficient
resources (92.9% before and 81.4% after the
program). Statistically significant differences were
observed for the lack of personal time, patient
overload, insufficient resources, and lack of skills to
practice EBM.
the findings of a study conducted by McCluskey and
Lovarini [9], who measured the changes in knowledge,
attitude, and behavior toward EBM after 2-day
workshops. There were statistically significant
differences in knowledge when scores before the
workshop and those after the workshop were
compared: there were significant gains in knowledge,
which were maintained at follow-up.
This study revealed statistically significant correlations
between age of physicians and knowledge scores, and
between age and attitude scores. There was a
significant positive correlation between years since
graduation and knowledge scores. A significant
correlation between years since graduation and
attitude scores was also observed.

However, the above-mentioned findings differ from

Discussion those of a study by Rashidbeygi and Sayehmiri [10],
In the present study, we found a statistically significant who found that physicians’ attitude toward EBM were
difference between knowledge scores after and before not significantly different between general practitioners,
the educational program. This was in agreement with specialists, and subspecialists. There was a significant
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92 Benha Medical Journal, Vol. 33 No. 2, July-December 2016

Table 12 Perceived barriers to practice evidence-based medicine from physicians’ opinions, before and after the educational
program
Barriers to EBM Preprogram (n = 112) [n (%)] Postprogram (n = 172) [n (%)] χ 2-Test P value
Lack of time
Yes 102 (91.1) 137 (79.7) 6.63 0.01
No 10 (8.9) 35 (20.3)
Patient overload
Yes 98 (87.5) 128 (74.4) 7.14 <0.001
No 14 (12.5) 44 (25.6)
Insufficient resources
Yes 104 (92.9) 140 (81.4) 7.36 <0.001
No 8 (7.1) 32 (18.6)
Lack of skills
Yes 102 (91.1) 142 (82.6) 4.06 <0.05
No 10 (8.9) 30 (17.4)
Colleagues attitude
Yes 106 (94.6) 153 (89.0) 2.74 >0.05
No 6 (5.4) 19 (11.0)
No financial gain
Yes 104 (92.9) 149 (86.6) 2.707 >0.05
No 8 (7.1) 23 (13.4)
Do not believe in EBM
Yes 58 (51.8) 98 (57.0) 0.738 >0.05
No 54 (48.2) 74 (43.0)
Fear of criticism
Yes 48 (42.9) 70 (40.7) 0.13 >0.05
No 64 (57.1) 102 (59.3)
Other barriers
Lack of data about EBM 8 (7.2) 20 (11.6) 1.53 >0.05
No training or real well
No 104 (92.8) 152 (88.4)

EBM, evidence-based medicine. Significant P value.

negative association between knowledge of physicians
and years since graduation.
Positive attitude toward the current promotion of
EBM was observed in the present study, as 73.4 and
82.3% of the physicians showed positive attitude
(welcoming, strongly welcoming) toward EBM
before and after the program, respectively. This was
in agreement with the findings of a study conducted by
Hart et al. [11], who found statistically significant
differences in attitude and beliefs about EBM
on the basis of the scores before and those after the
survey.
The percentage of physicians that attended courses in
EBM and critical appraisal increased after the
educational program (24.5 and 14.5%, respectively).
This was in line with the results of a study conducted by
Farihan et al. [5], which revealed that 20 and 17% of
the respondents had training courses in EBM and
critical appraisal, respectively.
(95.5 and 97.3%, respectively). This was in line with
the findings of a study by Al-Kubaisi et al. [12], as, in
their study, most of the physicians had access to the
Internet (92.2%).
No significant difference was observed in using the
Internet search to inform the clinical practice before
and after the educational program (69.1 and 72.9%,
respectively). This was similar to the results obtained by
Hussein [6], as more than three-quarter (76.4%) in that
study reported using the Internet in their clinical
practices.
This study showed that more than 80% of the
physicians reported reading medical journals: 82.4%
before and 86.4% after the program. This was in
agreement with the findings of a study by Al-
Kubaisi et al. [12], who mentioned that more than
one-third of the physicians (35.0%) read journals on
demand, 34.6% read them regularly, and 28.0% read
them occasionally.

The majority of the physicians had access to the There was a general agreement about the educational
Internet before and after the educational program methods to be used to move toward EBM practices,
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Impact of EBM education on KAP of physicians Wassef et al.
with the highest percentage of 83.2 and 88.2% for the
integration of EBM in the undergraduate course,
followed by workshops for training physicians
(67.3%). This was in agreement with the findings of
a study by Hussein [6], as the most popular method was
the integration of EBM in undergraduate courses
(80.8%), followed by a case review in the
departments (80.4%) and workshops for training
residents (79.6%).
These percentages are different from those reported in
the study conducted by Farihan et al. [5], as the
respondents’ opinions to move toward EBM had the
following order: training courses (58.3%) and followed
by case review (52%). This difference in opinions
between physicians in the previous studies could be
due to that participants in the present study still
making postgraduate studied, and thus the
integration of EBM courses in undergraduate and
postgraduate curriculums will be more beneficial to
them compared with other educational methods.
In the present study, the physicians mentioned the
different sources of information they used when they
faced problems during patient management. Verbal
consultation from a senior staff was 68.6% before
and 79.7% after the program; reading textbooks and
handbooks accounted for 68.6% before and 75% after
the program. Those methods were the commonest
methods used by physicians to solve clinical
problems during patient management. The method
used least was searching on the Internet (29.6%
before and 37.3% after the program).
This same order was reported in the study conducted
by Isamail et al. [13], as the most common source
was taking consultations from senior staff (71.6%),
followed by searching in textbooks (46.6%).
After the educational program, a higher percentage of
participants (57%) reported that they did not believe in
EBM as a barrier than those who had done so before
(51%), as they complained that doctor experience was
of no value compared with evidence-based facts. This
difference was not statistically significant. There were
significant differences (a decrease) in the proportion
of physicians reporting insufficient resources (92.9%
before and 81.4% after the program) as barriers
to practice EBM, as they became aware of the
advantages of practicing EBM.
These findings differ from those reported by
McCluskey and Lovarini [9], as after the workshop,
a higher percentage of participants (94%) reported lack
93
of time as a barrier than had done so before (75%), as
they became aware of what evidence-based practice
involved. The proportions reporting limited search
skills as a perceived barrier changed from 61%
before to 53% after the workshop, and 24% at
follow-up. The proportions reporting limited
appraisal skills as a perceived barrier changed from
60% before to 65% after the workshop, and 41% at
follow-up.
Conclusion
After conducting the educational program, knowledge
of evidence-based practice improved markedly with a
targeted educational intervention. Physicians’ attitude
toward EBM was positive before and after the
program. However, changes in practice were small,
based on the frequency of searching and appraisal
activities. Physicians need more teaching and
training to ensure they correctly apply EBM in their
daily patient care. These trainings should be integrated
in both undergraduate and postgraduate courses taking
into consideration the barriers that were mentioned by
the physicians, which interfere with their use of EBM.
Recommendations
Implementation of EBM needs further improvement.
Several interventions have become clear from our
findings and experience in creating a professional
environment that incorporates EBM in daily medical
practice. Incorporating and inflating time spent on
EBP by refining and modifying curriculum and
education style in postgraduate and undergraduate
medical curricula; interactive, face-to-face education
in clinical practice; allowing for optimum content at the
bedside; and accessing, appraising, and interpreting
guidelines, research and protocols, basic statistical
analysis, and research training are recommended.
Physicians may further enhance their efficiency by
using computerized decision support systems, which,
embedded in clinical information systems, aid in
decision-making.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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