Article Type: Research Article Article Citation: Naba’a Alkhair ALshaikh, Haghamad Allzain, and Bashier Eltayeb Shumo. (2021). KNOWLEDGE,
ATTITUDE AND PERCEPTION TOWARD EVIDENCE BASED MEDICINE AMONG MEDICAL STUDENTS
IN SHENDI UNIVERSITY- SUDAN. International Journal of Research -GRANTHAALAYAH, 9(3),
149-155. https://doi.org/10.29121/granthaalayah.v9.i3.2021.3773 Received Date: 02 March 2021 Accepted Date: 30 March 2021 Keywords: Evidence Medicine Knowledge Attitude Perception Cochrane Abbreviations EBM,
Evidence-based medicine; EBP, Evidence-Based Practice ; UK, United Kingdom;
RCR, Randomized Controlled Research ; SPSS, Statistical Package for Social
Sciences; WHO, World Health Organization. ABSTRACT Evidence-based medicine (EBM) is the “conscientious, explicit, and judicious use of current best evidence (Thamer Z. et al. 2018 .It is the evolving science of clinical care. It is the judicious use of the best current evidence in making decisions about the care of the individual patient. It also integrates clinical expertise, patient desires, values, and needs . (Michael LeFevre.2014 ) The current study intended to assess Knowledge, attitude and perception toward EBM among medical students in Shendi University in Sudan. It was descriptive cross-sectional one, from October to December 2020; It included one hundred and twenty one (121) medical students. Data was collected employing structural self –administered questionnaire and the data collected was analyzed by SPSS. The findings of the study described the current status of level of awareness and use of EBM .More than half of students have poor knowledge toward EBM. Approximately half or less have good attitude compared with their poor knowledge, while the perception of the importance of evidence based medicine was good (72%).
1. INTRODUCTIONInnovation
in information technology alongside massive increase in biomedical research has
given rise to changing biomedical literature varying in quality and clinical
relevance. Also the increasing utilization of social
media in reflective peer-to-peer learning and the media manipulation
encountered . This has led to the adoption of evidence-based medicine (EBM) as the new
paradigm for medical practice (Francisco Jose Grajales,
et al .2014 ;Jens R. Chapman, et al 2018). The term EBM was coined by
Gordon Guyatt in 1992, which is based on the integration of
research, patient preferences, and clinical experience. EBM's
placing the practice of medicine on a solid scientific basis (EBM Working Group. 1992) . It promotes the development of more
sophisticated hierarchies of evidence, the recognition of the crucial role of
patient values and preferences in clinical decision making, and the development
of the methodology for generating trustworthy recommendations (Benjamin Djulbegovic & Gordon H Guyatt. 2017) . David Lawrence Sackett a clinical epidemiologist, and
founding Chair of the Cochrane Collaboration is widely regarded as a pioneer
and the father of EBM. Sackett and his colleagues focused on the need to not
only teach methods to understand the scientific literature but also to teach
the application of new information to the physicians. It has been described as
one of the most important medical advancements in the past one hundred and
fifty (150) years, alongside the discovery of vaccines and antibiotics. The Cochrane Collaboration
is a non-profit organization established in (1993) in the UK. (H V Worthington , et al 2013). It comprises over ten thousand (10,000) scientist
worldwide. Its main mission is to go through and prepare systematic
reviews of new research that is being published every day in various
specialties based on the strongest evidence available, in order to help
make informed decisions on healthcare interventions for the best possible
patient outcome (J Taylor, et al .2017) . EBM
represents integration of clinical expertise, patient’s values and best
available evidence in process of decision making related to patients
health care (IzetMasic, etal.
2008). It is one of these essential
elements of practice becoming part of medical curricula around the world
(Mylene Lévesque, et al 2018). EBM has
thus become an impetus for incorporating a critical appraisal of research
evidence alongside routine clinical practice. The acquisition of knowledge and
skills for EBM is becoming a core competence for all doctors. There is an
increasing emphasis on the teaching of EBM skills in undergraduate,
postgraduate, and continuing medical education programs (Thamer
Z.et al 2018). The main
reason for practicing EBM is to improve quality of care through the
identification and promotion of practices that work, and the elimination of
those that are ineffective or harmful. EBM promotes critical thinking, and
important for health care professionals to develop key EBM skills, including
the ability to find, critically appraise, and incorporate sound scientific
evidence into their own practice (A K Akobeng. 2005)
The
practice of evidence-based medicine is a process of lifelong, self-directed, problem-based
learning in which caring for one’s own patients creates the need for clinically
important information about diagnosis, prognosis, therapy
and other clinical and health care issues. Its good application brings
cost-effective and better health care. The key difference between EBM and
traditional medicine is not that EBM considers the evidence while the latter
does not. Both take evidence into account; however, EBM demands better evidence
than has traditionally been used (Izet Masic , et al .2008) As EBM is
a “conscientious, explicit and judicious use of
current best evidence in making decisions about the care of an individual
patient , its teaching is recommended as an essential part of
medical/clinical education (van Buljan, etal 2018). The need
and demand for evidence based practice in health care is growing rapidly
because of information overload, rising patient expectations, new and advanced
technologies and aging population.. The
practice of EBM involves formulating answerable clinical questions, finding, appraising and applying the evidence and evaluating
performance (Farley library research guides. 2020, Centre for EBM. 2020). Therefore,
EBM is a conceptual approach of the physician in making decisions related to
the individual patient. Unlike this, evidence-based health care is somewhat
broader concept that includes advanced approach to understanding the patients,
families and doctors’ beliefs, values and
attitudes. It also relies on evidence,
but primarily those on population level (Izet Masic , et al .2008). Evidence
needs to realize that it is a tool in the toolbox to inform doctors but to have
any credibility it needs to be used on a scale and in a way which generates
real confidence (Editorials.2017). Therefore evidence
levels can be classified into evidences obtained from: 1)
(1a)
Meta-analysis of several randomized controlled research (RCR). 2)
(1b)
Only one randomized controlled research RCR. 3)
(2a)
Well-designed controlled research RCR. 4)
(2b)
One quasi experimental research. 5)
(3)
Non-experimental studies (comparative research, case study), according to some,
for example Textbooks. 6)
(4)
Experts and clinical practice (Dang, D. & Dearholt,
S.L. 2018 ). Hierarchy of evidence is the levels of
evidence assigned to studies based on the methodological quality of their
design, validity and applicability to patient care
(Darrell .W.2020). It provides a framework for ranking evidence that evaluates
health care interventions and indicates which studies should be given most
weight in an evaluation where the same question has been examined using
different types of study (Elizabeth Ayetley, et al
2016). Evidence-based
practice (EBP) is believed to be associated with improved health, safety, and
cost outcomes. Most medical practice in low- and middle-income countries is not
evidence-based (Getenet Dessie, et al 2020). Healthcare
decisions are increasingly being based upon research-derived evidence, rather
than on expert opinion or clinical experience alone, although Interpreting and
understanding evidence synthesis, systematic reviews and other analytic
literature is a difficult task. (Laxmaiah Manchikanti , et al 2007; J C Craig, et al .2001 ) 2. RATIONALEEBM is an
essential method of teaching that is applied in clinical decision making,
therefore studying of knowledge, attitude and
perception of EBM among medical students help to evaluate their knowledge and
ability to use EBM to improve the quality of health care. This
research will help emphasize the importance of applying EBM in the curriculum
of medical students. The
objective of this study to evaluate Knowledge, attitude
and perception toward EBM among medical students in Shendi
University in Sudan. 3. METHODOLOGYThe
current study was descriptive cross-sectional one, carried out from October to
December 2020 in the Faculty of Medicine in Shendi
University in Sudan. It included one hundred and twenty one
(121) medical students, as non probability
convenience sample. Data was collected by individual interviewing, self-
administrated questionnaire and analyzed by the soft ware
SPSS for windows version (22).The references were managed manually using
Harvard style. 4. ETHICAL CONSIDERATION The study
was approval by the department of community medicine in the Faculty of Medicine
- Shendi University. 5.
RESULTS
Table 1: The knowledge statements
Table 2: The attitude statements
Table 3: The perception statements
4. DISCUSSIONThis
study was cross-sectional descriptive, conducted in Shendi
University to assess evidence based medicine
knowledge, attitude and perception among students; the study population were
medical students. Clinical
expertise is one of the three components of Evidence-based medicine the answers
were 14% for (Famous text book), 10% for (WHO reports), 9% for (senior
consultant’s opinion, Evidences,) and 9% for (Your patient’s choice).The
multiple options answers were 17% for (Evidence+ WHO reports), 10% for
(Evidences+ the patient’s choice), 9% for (Famous text books + senior
consultant’s opinion), 6% for (Famous text books + WHO reports), 5% for (senior
consultant’s opinion + Evidences), 3% for (Famous text book + Evidence), 3% for
(WHO reports + the patient’s choice), 2% for (senior consultant’s
opinion + Who reports), 1% for (Famous text books + the patient’s choice) and
also 1% for (Famous text books + senior consultant’s opinion). 35% of the students know that systematic review
is what provide the strongest evidence in
‘Hierarchy of Evidence’ in evidence based
medicine concept In another study in Saudi Arabia in the same article 40.4%
appreciated that the strongest evidence to EBP is systematic review (Thamer Z. et al 2018). Students
when asked if they know Cochrane library75% of them said no and 25% said yes,
in comparison with students in Saudi Arabia when asked the same question 95% of
the respondents were not aware of the Cochrane Library (CL), so regarding to
that the level of knowledge about Cochrane library in Shendi
university was good (Thamer Z. et al 2018). When
students asked if they discover that recent evidence contradicts clinical
judgment what will they do 49% will (Evaluate the evidence), 39% said that they
will(Follow the evidence) and 12% go with
(Discard the evidence). Using
books was the choice of 37% of students and 36% said they will find out
information from any websites , 15% said (Seeing the latest article) and 12%
said (Asking your consultant) as an answer about If there is a discussion in
any medical information, what will they do to know the answer, when the same
question was asked to medical students
of king Abdulaziz university in Saudi Arabia 7.1% said
(Using books), 0%said (Find out from any website), 50% said (Seeing the latest
article) and 42% said (Asking your consultant) (HussamAlbugami,
et al. 2017). Students
were asked if they interested in searching for medical updates 46% said
(Sometimes), 30% for (Always), 22% for (Often) and 2% for (Never), other study
in the same article made in king abdulaziz university
students respond to same question with different choices were 92.9% for (yes)
and 7.1% for (no) (HussamAlbugami, et al. 2017).. About the
interesting of the students to know the sensitivity and specificity of any
signs, symptoms or lab result 52% says they always interested about knowing it,
in the other side 78% of king abdulaziz university students also have the interested
to know (HussamAlbugami, et al. 2017). 72% of
the students agree when they asked about their agreement of important of EBM
during undergraduate education, 27% were Neutral and 1% disagree. More than
half of students (66%) think they (Sometimes) patients are willing to
participate in clinical decision making, 26% said patient are (Always) in the
other side 87.1% of medical students in
deferent universities in Saudi Arabia says (Yes) for the participation of
patients in clinical decision making(Thamer Z. et al
2018). Students
were asked if they have an account in any medical database library as question
to assess their attitude and perception about EBM 59% said (No) and 41% said (Yes) (HussamAlbugami, et al. 2017). The
knowledge of the medical student of Shendi university
about EBM was poor. Their
attitude toward it was good but not the best and that mostly because of the
poor knowledge of them about EBM. Their
perception was significantly good especially about the important of the EBM and
that may increase their interest to get more knowledge about it 5. CONCLUSIONThe
findings of this study described the current status of
level of awareness and use of EBM among the medical students. More than half of
students have poor knowledge toward evidence based
medicine , and approximately half have good attitude compared with their poor knowledge ,while the
perception of the importance of EBM was good (72%). 6. RECOMMENDATIONS It was recommended that EBM to be incorporated
in medical schools curricula and to raise the
awareness of the students about it, as new concept for contemporary and future
medical practices. Authors, contributions 1)
Dr
.Naba’a Alkhair ALshaikh: the principal investigator collected the data,
interpreted the data generated. 2)
Dr.
Haghamad Allzain : wrote
and enriched the manuscript. 3)
Dr.
Bashier Eltayeb Shumo: the
supervisor of the research, conceived the idea , provide critical
suggestions, and follow up the course of
the research. SOURCES OF FUNDINGThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. CONFLICT OF INTERESTThe author have declared that no competing interests exist. ACKNOWLEDGMENTThe authors appreciated the
participation of the medical students in Shendi
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