Table 1.

Presentation of main themes, sub-categories and sample of components by clinical faculty members of Kermanshah University of Medical Sciences

Major Categories	Sub-categories	Explanations and Sample Comments
Unaware and Disuse of EBM	Unaware of Concept	sample of comments: I haven’t heard of it, I almost know nothing of it, I have no idea and haven’t heard of it yet, I haven’t heard of this phrase so far, I haven’t trained in this area.
	Disuse of EBM	Other people don’t use it. I have no idea so I don’t use it and it isn’t used. It is used slightly. It is still a long way for our country to know that this method is useful. Doctors who prescribe the same for all patients and consider the patients similarly don’t use this method. If the adults do it, they inspire the minors…
	Referral to Clinicians	We send them to another doctor who specializes in this field and say that this is my diagnosis and seek his idea. I send to a doctor who is specialized or more experienced.
	Prescription of Test and Para-clinical Efforts	If it is a chronic disease and we cannot diagnose, we prescribe experiments and so on. Unless I get them to do some diagnostic processes and wait to get ultrasound and C.T. results, I do search the same day.
Conscious or Unconscious Use of EBM	Using Journals	At the first place, I use journals.
	Using Scientific Websites	If I get nowhere through consultancy and colleagues, I will search through websites- first, I go to books, then the colleagues and finally the websites: scientific ones such as Google Scholar. I’d rather using websites to my earlier hand-written notes. If there is an ambiguous case, I do search and get some articles from credible websites and journals and examine the solutions. Then, I follow the treatment process. I use Up to Date Medicine and Medscape….
	Having Info & Awareness on EBM	I became familiar with this phrase when I was in Isfahan, when I was a university student. Back then I took part in its workshops. As we are faculty members and committed and we hold some sessions per month and are quite familiar with this phrase and we use it in our processes but the rest of people don’t have to. I am quite familiar with EBM and use it. I regard it as doctors’ consultation in rare cases along with various searches to get to a comprehensive idea.
	Consultancy with colleagues	I consult or call my colleagues. I consult with pathologist colleagues like dr. … or with specialized ones. If searching is pointless, I do consult with others and ask other professors, experienced or in experienced, if they have ever encountered this problem or not. At my residency, there was a patient with meningitis with no natural trend. Having consulted the professors, he was diagnosed with lupus. First of all, I consult with professors, then my own personal searches. I search the websites if consultancy with colleagues is pointless…
Beliefs on EBM	Using EBM method	I put off the treatment for searching information. I use this method in my treatment process. In fact, I search for newer things and why it has lost its natural process? Then, I notice that I should search. I searched based on the case I had. After patient’s examination, I do search the same day since I should take my decisions rapidly. I am always connected and search the unknown case right away. I spend the treatment process based on my findings. I search 3 to 4 articles per night for side effects of a drug or illness symptom. I search the latest developments. For example, a patient takes drugs which may have interposing side-effects. I do my searches and tell him the results tomorrow. For instance, the patient is diagnosed with psoriasis or fat liver. Then, he asks me about the relationship. If I am informed, I’ll answer. If not, I ask them to come back for the results later and I do my searches during this time since I have little information on drugs (I am specialized in another field.)
	Belief on Importance and Necessity of EBM	Using this method would help in diagnostic and para-clinical efforts. Diagnosis and treatment trend happen fast. Tumor cases are large. There is a new case everyday coming up and we should comment on it. Some time ago, a baby was born with two short and two long members. And there is no similar case mentioned in any books. Using the websites in these cases is significant. If Health and Treatment Ministry stresses that no one patients would ever face any problems with this method, if diagnosis and treatment happen based upon the evidence, it bears lots of benefits for the patients. When the books are helpless, using websites is essential (EBM). I believe this is very efficient but it requires pre-training. There are many new cases of internal patients and the search is essential. I put off the treatment process and draw conclusions after the search: one of the benefits is that if there is a patient with gastrointestinal hemorrhage, all the judges would be the same. But, they search; they realize that it may be of another type….
	Belief on Non-necessity of EBM	I go to several hospitals. I get home at 9. I do the chores and I have no time for studying or research. I should make money and earn a living. A pediatrician examines a patient of 99 just for making money. EBM doesn’t work for us. In emergency cases, there is no opportunity to visit. It isn’t used because it isn’t realistic. As there isn’t sufficient internet in hospital, it is slightly used (just in library). There is a long way a head in our country to believe that this is a useful method. If you search for something, they may say you are not updated. When you search or read a book, the patient may lose its faith in you. Doctors, who prescribe the same drugs for all patients and see the patients alike, don’t use this method. If the adults or more precedent do this, they will be inspiring for the minors.