Abstract
BACKGROUND: Clinical governance will require general practitioners (GPs) and practice nurses (PNs) to become competent in finding, appraising, and implementing research evidence--the skills of evidence-based health care (EBHC). AIM: To report the experiences of GPs and PNs in training in this area. METHOD: We held 30 in-depth, semi-structured interviews throughout North Thames region with three groups of informants: primary care practitioners recruited from the mailing lists of established EBHC courses; organizers and teachers on these courses; and educational advisers from Royal Colleges, universities, and postgraduate departments. Detailed qualitative analysis was undertaken to identify themes from each of these interview groups. RESULTS: At the time of the fieldwork for this study (late 1997), remarkably few GPs or PNs had attended any formal EBHC courses in our region. Perceived barriers to attendance on courses included inconsistency in marketing terminology, cultural issues (e.g. EBHC being perceived as one aspect of rapid and unwanted change in the workplace), lack of confidence in the subject matter (especially mathematics and statistics), lack of time, and practical and financial constraints. Our interviews suggested, however, that the principles and philosophy of EBHC are beginning to permeate traditional lecture-based continuing medical education courses, and consultant colleagues increasingly seek to make their advice 'evidence based'. CONCLUSION: We offer some preliminary recommendations for the organizers of EBHC courses for primary care. These include offering a range of flexible training, being explicit about course content, recognizing differences in professional culture between primary and secondary care and between doctors and nurses, and addressing issues of funding and accreditation at national level. Introducing EBHC through traditional topic-based postgraduate teaching programmes may be more acceptable and more effective than providing dedicated courses in its theoretical principles.
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Selected References
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- Bligh J. Problem based, small group learning. BMJ. 1995 Aug 5;311(7001):342–343. doi: 10.1136/bmj.311.7001.342. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cranney M., Walley T. Same information, different decisions: the influence of evidence on the management of hypertension in the elderly. Br J Gen Pract. 1996 Nov;46(412):661–663. [PMC free article] [PubMed] [Google Scholar]
- Fox R. D., Bennett N. L. Learning and change: implications for continuing medical education. BMJ. 1998 Feb 7;316(7129):466–468. doi: 10.1136/bmj.316.7129.466. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Greenhalgh T., Macfarlane F. Towards a competency grid for evidence-based practice. J Eval Clin Pract. 1997 Apr;3(2):161–165. doi: 10.1046/j.1365-2753.1997.00082.x. [DOI] [PubMed] [Google Scholar]
- Hagdrup N., Falshaw M., Gray R. W., Carter Y. All members of primary care team are aware of importance of evidence based medicine. BMJ. 1998 Jul 25;317(7153):282–282. doi: 10.1136/bmj.317.7153.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hicks C., Hennessy D., Cooper J., Barwell F. Investigating attitudes to research in primary health care teams. J Adv Nurs. 1996 Nov;24(5):1033–1041. doi: 10.1111/j.1365-2648.1996.tb02940.x. [DOI] [PubMed] [Google Scholar]
- Hicks C., Hennessy D. Mixed messages in nursing research: their contribution to the persisting hiatus between evidence and practice. J Adv Nurs. 1997 Mar;25(3):595–601. doi: 10.1046/j.1365-2648.1997.1997025595.x. [DOI] [PubMed] [Google Scholar]
- Lloyd J., Ross K. Project to develop an autonomous practitioner programme. J Nurs Manag. 1997 Sep;5(5):267–270. doi: 10.1046/j.1365-2834.1997.00022.x. [DOI] [PubMed] [Google Scholar]
- McColl A., Smith H., White P., Field J. General practitioner's perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998 Jan 31;316(7128):361–365. doi: 10.1136/bmj.316.7128.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morris B. A., Kerbel D., Luu-Trong N. Family practice residents' attitudes toward their academic projects. Fam Med. 1994 Oct;26(9):579–582. [PubMed] [Google Scholar]
- Toghill P. Continuing medical education: where next? BMJ. 1998 Mar 7;316(7133):721–722. doi: 10.1136/bmj.316.7133.721. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wood I. The effects of continuing professional education on the clinical practice of nurses: a review of the literature. Int J Nurs Stud. 1998 Jun;35(3):125–131. doi: 10.1016/s0020-7489(98)00021-2. [DOI] [PubMed] [Google Scholar]