Career stage and work setting create different barriers for evidence-based medicine

Area of Science:

• Medical Education
• Health Services Research
• Clinical Practice

Background:

• Barriers to evidence-based medicine (EBM) practice are known, but a comprehensive classification framework is lacking.
• Understanding clinician-specific factors influencing EBM adoption is crucial for effective implementation.

Purpose of the Study:

• To explore the relationship between career stage and work setting on perceived barriers to EBM practice among doctors.
• To develop a novel framework for classifying barriers to practicing EBM.

Main Methods:

• Qualitative study using purposive sampling of doctors across three career stages (registrars, consultants, senior anaesthetists).
• Data collected through semi-structured interviews in academic and general hospital settings.
• Grounded theory approach employed to develop a classification framework for EBM barriers.

Main Results:

• Registrars faced information overload and hierarchical dependence; consultants relied on confidence-based medicine.
• Senior doctors, combining clinical work with leadership, were more reflective and receptive to EBM.
• General hospitals presented unique challenges, including lack of formal hierarchy and hindered interdisciplinary collaboration.
• Ten conditions conducive to EBM practice were identified.

Conclusions:

• Both career stage and work setting are significantly associated with perceived barriers to EBM.
• A theoretical framework classifying these barriers has been developed, incorporating career stage and work setting differences.