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Research Article

How can we teach EBM in clinical practice? An analysis of barriers to implementation of on-the-job EBM teaching and learning

Katrien Oude Rengerink University of Amsterdam, The Netherlands; KATRIEN OUDE RENGERINK, MSc, is an Epidemiologist at the Academic Medical Center, Amsterdam, the Netherlands.Correspondence[email protected]

Shakila Thangaratinam Birmingham Women's NHS Foundation Trust, UK; University of Birmingham, UK; SHAKILA THANGARATINAM, MRCOG, is a Clinical Lecturer in Obstetrics and Gynaecology and Clinical Epidemiology at Birmingham's NHS Foundation Trust, Birmingham, United Kingdom.

Gemma Barnfield Birmingham Women's NHS Foundation Trust, UK; University of Birmingham, UK; GEMMA BARNFIELD, BSc (Hons) Midwifery, is a Research Midwife at Birmingham Women's NHS Foundation Trust, Birmingham, United Kingdom.

Katja Suter Basel Institute for Clinical Epidemiology, Switzerland; KATJA SUTER, PhD, is a Pharmacist and Research Fellow at the Basel Institute for Clinical Epidemiology, Basel, Switzerland.

Andrea R. Horvath University of Szeged, Hungary; ANDREA R. HORVATH, MD, PhD, FRCPath, EurClinChem, is a Professor and Head of Department of Laboratory Medicine and of the TUDOR EBM Network, University of Szeged, Hungary. Currently on sabbatical leave as Clinical Director at SEALS Clinical Chemistry, Prince of Wales Hospital, and honorary professor at the University of Sydney, Screening and Test Evaluation Program of the School of Public Health.

Jacek Walczak CASPolska, Poland; JACEK WALCZAK, MD, is an HTA expert at CASPolska, Krakow, Poland.

Anna Wełmińska CASPolska, Poland; ANNA WEŁMIŃSKA, MSc in Public Health, MSc in Biology, MARR RA Krakow, Poland.

Susanne Weinbrenner Agency for Quality in Medicine, Germany; SUZANNE WEINBRENNER, MD, PhD, is an Anesthetist, Public Health Specialist and Head of the EBM and Guideline Department, Agency for Quality in Medicine, Berlin, Germany.

Berit Meyerrose Agency for Quality in Medicine, Germany; BERIT MEYERROSE, MD, PhD, is a scientific staff member at the Agency for Quality in Medicine, Berlin, Germany.

Theodoros N. Arvanitis University of Birmingham, UK; THEODOROS N. ARVANITIS, RT, DPhil, CEng, FSIM, FRSM, is a Reader in Biomedical Informatics, Signals and Systems at the University of Birmingham, while he holds an honorary Clinical Scientist's post at Birmingham Children's Hospital, Birmingham, United Kingdom. His research interests include biomedical imaging and spectroscopy, biomedical informatics, e-health and telemedicine.

Rita Ónody University of Szeged, Hungary; RITA ÓNODY, PhD, is a Biologist, Head of the Hemostasis Division of the Department of Laboratory Medicine, University of Szeged, Hungary.

Gianni Zanrei Universita Cattolica del Sacro Curore, Italy; GIANNI ZANREI, Eng, is a Professor and Technical Expert at the Universita Cattolica del Sacro Curore, Piacenza, Italy.

Regina Kunz Basel Institute for Clinical Epidemiology, Switzerland; REGINA KUNZ, PhD, MD, MSc, is a Professor of Clinical Epidemiology, Deputy Director, Nephrologist and Clinical Epidemiologist at the Basel Institute for Clinical Epidemiology, Basel. Switzerland. Her current affiliation is Academy of Swiss Insurance Medicine, ASIM, University Basel.

Chantal Arditi University of Lausanne, Switzerland; CHANTAL ARDITI, MSc, is a Health Services Researcher at the Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.

Bernard Burnand University of Lausanne, Switzerland; BERNARD BURNAND, MD, MPH, is a Professor, Head of the Healthcare evaluation unit at the Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.

Harry Gee Birmingham Women's NHS Foundation Trust, UK; HARRY GEE, MBBS, MD, FRCOG, is a Consultant Obstetrician and Medical Director at Birmingham Women's Hospital, Birmingham, United Kingdom.

Khalid S. Khan Birmingham Women's NHS Foundation Trust, UK; University of Birmingham, UK; KHALID S. KHAN, is a Professor of Women's Health and Clinical Epidemiology, Barts, and the London Medical School, Queen Mary University of London, United Kingdom.

Ben W. J. Mol University of Amsterdam, The Netherlands; BEN WILLEM J. MOL, MD, PhD, is a Professor in Obstetrics, Gynecology and Clinical Epidemiology at the Academic Medical Center in Amsterdam, the Netherlands.

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Abstract

Introduction: Evidence-based medicine (EBM) improves the quality of health care. Courses on how to teach EBM in practice are available, but knowledge does not automatically imply its application in teaching. We aimed to identify and compare barriers and facilitators for teaching EBM in clinical practice in various European countries.

Methods: A questionnaire was constructed listing potential barriers and facilitators for EBM teaching in clinical practice. Answers were reported on a 7-point Likert scale ranging from not at all being a barrier to being an insurmountable barrier.

Results: The questionnaire was completed by 120 clinical EBM teachers from 11 countries. Lack of time was the strongest barrier for teaching EBM in practice (median 5). Moderate barriers were the lack of requirements for EBM skills and a pyramid hierarchy in health care management structure (median 4). In Germany, Hungary and Poland, reading and understanding articles in English was a higher barrier than in the other countries.

Conclusion: Incorporation of teaching EBM in practice faces several barriers to implementation. Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

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How can we teach EBM in clinical practice? An analysis of barriers to implementation of on-the-job EBM teaching and learning

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