Identifying barriers to the adoption of evidence-based medicine practice in clinical clerks: A longitudinal focus group study

Abstract

OBJECTIVE: To identify and explore common barriers to the adoption of evidence-based medicine (EBM) practice in the undergraduate setting. DESIGN: Nested longitudinal, focus group-based, qualitative study. SETTING: The University of Hong Kong Medical School, Hong Kong, China. PARTICIPANTS: A group of 39 Year 4 medical undergraduates who participated in an EBM intervention cluster randomised crossover trial. MAIN OUTCOME MEASURES: Students' attitudes, opinions and perceptions of barriers to EBM use. RESULTS: General attitudes towards EBM and the teaching intervention were positive. Four sets of barriers to greater EBM use were identified as follows. (1) Learning environment including prevailing norms for student learning involving examination-oriented, textbook learning, prior availability of clinical practice guidelines, lack of encouragement from teachers and economy of time by utilising teacher expertise. (2) Limitations of evidence consisting of poor point-of-care access to medical literature, difficulty in locating evidence and the perceived low relevance of overseas evidence to Chinese patients. (3) Lack of opportunity to practise EBM due to lack of continuity of care and anxieties about negative teacher attitudes towards EBM use at the point-of-care. (4) Time constraints such as competing study demands and long evidence search time. CONCLUSIONS: Significant barriers to the successful implementation of EBM learning in the clinical clerkship setting were identified. These can be specifically targeted to ameliorate any inhibition of clinical learning they may impose.