Description of Respondents
Of the 521 questionnaires distributed, 26 (5%) were ruled ineligible because the physicians had died (1), moved without forwarding address (2), retired from active practice (11), or reported that they did not spend any time in direct patient care (12). Of the 495 eligible questionnaires, 296 (60%) were returned to the study coordinating center; 2 incomplete surveys were excluded from further analysis, and the final sample thus consisted of 294 completed surveys.
The demographic characteristics of respondents were similar to those of all members of the Canadian Society of Internal Medicine, in mean age (46 years), gender (80% male), and location of practice (52% in large urban centers) (data not shown). Approximately 20% of Canadian physicians practicing as general internists are members of the Canadian Society of Internal Medicine (1995 Royal College of Physicians and Surgeons of Canada Work Force Study, unpublished data). Although members of the Canadian Society of Internal Medicine have a similar age distribution as nonmembers, members are more likely to be female (20% vs 12%, p < .0001), have academic appointments (53% vs 39%, p < .0001), and have teaching responsibilities (62% vs 48%, p < .0001). Conversely, nonmembers are more likely to spend more than 20 hours per week in direct patient care (91% vs 84%, p < .0001). When asked how often they employed EBM in their clinical practice, 33 (11%) of the 294 respondents stated “always,” 173 (59%) “often,” 80 (27%) “sometimes,” and 8 (3%) “rarely/never.”
In comparing the demographic characteristics of EBM users with EBM nonusers, no significant differences were detected on univariate analysis () or multivariate analysis (data not shown). In particular, those respondents with academic appointments were no more likely to state that they use EBM than respondents without academic appointments (70% vs 71%, p = .80). Moreover, there were no significant differences between the 33 physicians who reported that they “always” used EBM and the other 261 respondents for those items listed in (data not shown).
Demographic Characteristics of Respondents, by Self-reported Frequency of Use ofEvidence-Based Medicine (EBM) Principles in Clinical Practice
Attitudes Toward Evidence-Based Medicine
Self-identified EBM users more often agreed with positive statements about EBM and its impact on patient outcomes and cost-effectiveness of care than did EBM nonusers. However, the vast majority of both groups felt that EBM helps clinical decision making and that physicians should be able to critically appraise the literature. Although EBM nonusers were more likely to feel that EBM was the purview of academics, only a minority of respondents agreed with statements of possible barriers to the practice of EBM ().
Attitude Toward Evidence-Based Medicine (EBM)
Preferred Sources of Information
Despite the general enthusiasm for EBM, only a minority of respondents reported frequently using evidence-based clinical practice guidelines or studies identified from a focused literature search to guide their clinical decisions (although EBM users were significantly more likely to use these resources than EBM nonusers). Clinical experience, review articles, and the opinion of colleagues were the favored sources of information for both groups of physicians (). Information sources that only a few respondents stated they “frequently used” included the Internet (10%), Cochrane Collaboration Reviews (5%), and pharmaceutical industry representatives (2%).
FIGURE 1 Use of information sources to guide clinical decision making. Results are expressed as percentage of respondents who reported using the information sources “often” or “always.” Research articles defined as “articles (more ...)
The median number of professional journals regularly read by respondents was 4 (no difference between EBM users and nonusers, p = .32). While 214 (73%) reported reading professional literature for more than 1 hour per week, only 46 (16%) read for more than 4 hours per week; after excluding the 40 physicians who were currently pursuing further postgraduate training, only 14% of physicians practicing “full-time” read for more than 4 hours per week. Reported reading times were greater ( p = .015) for EBM users than nonusers; for example, 19% of EBM users reported reading professional literature more than 4 hours per week compared with 7% of nonusers.
Confidence in Evidence-Based Medicine Skills
While most respondents felt comfortable in their ability to formulate a clear question based on a specific patient problem, less than half felt confident in the other basic skills of EBM (). In particular, respondents were least comfortable with critical appraisal of identified studies. However, 93% felt that physicians must be able to critically appraise the literature (), and there was a high level of interest in task-specific training (56% requested a continuing medical education event on critical appraisal). Not surprisingly, EBM users expressed more confidence in literature searching and critical appraisal (both p < .01).
Percentage of respondents expressing confidence in basic evidence-based medicine (EBM) skills. *p < .01 for comparison between EBM users and nonusers.