Kitto Simon, Villanueva Elmer V, Chesters Janice, Petrovic Ana, Waxman Bruce P, Smith Julian A
Department of Surgery, Monash Medical Centre and School of Rural Health, Monash University, Moe, Victoria, Australia.
ANZ J Surg. 2007 Apr;77(4):231-6. doi: 10.1111/j.1445-2197.2007.04022.x.
Within surgery the debate about the place of evidence-based medicine (EBM) has focused on the nature and compatibility of EBM with surgical practice with an inevitable polarization of opinion. However, EBM techniques are being embedded into undergraduate medical curricula and surgical training programs across Australia. The Monash University Department of Surgery at Monash Medical Centre implemented a pilot study to explore current knowledge, attitudes and behaviours of practising surgeons towards EBM techniques.
Descriptive survey of surgeons based in a tertiary care environment.
The results from the surgeons surveyed suggest that (i) they believe that EBM marginalizes patient involvement in decision-making; (ii) they believe that EBM-generated knowledge is useful and is commonly used in daily clinical decision-making--however, not using EBM does not adversely affect their daily clinical decision-making; (iii) they have high confidence in their own judgement compared with low confidence in clinical practice guidelines and other sources of evidence; and (iv) journal summaries of the latest research related to a subject are the most useful resources in clinical practice above clinical practice guidelines.
The importance of incorporating concepts of the 'culture' of surgery as an important factor in understanding and developing new ways to mobilize Australian surgeons to adopt EBM into their practice is discussed.
在外科领域,关于循证医学(EBM)地位的争论聚焦于循证医学与外科实践的本质及兼容性,观点不可避免地出现了两极分化。然而,循证医学技术正被纳入澳大利亚各地的本科医学课程和外科培训项目。莫纳什大学莫纳什医疗中心外科系开展了一项试点研究,以探索执业外科医生对循证医学技术的现有知识、态度和行为。
对处于三级医疗环境中的外科医生进行描述性调查。
接受调查的外科医生的结果表明:(i)他们认为循证医学将患者参与决策的机会边缘化;(ii)他们认为循证医学产生的知识是有用的,并且在日常临床决策中常用——然而,不使用循证医学并不会对他们的日常临床决策产生不利影响;(iii)与对临床实践指南和其他证据来源的低信心相比,他们对自己的判断有很高的信心;(iv)在临床实践中,与某一主题相关的最新研究的期刊摘要比临床实践指南更有用。
讨论了将外科“文化”概念作为理解和开发新方法以促使澳大利亚外科医生在实践中采用循证医学的一个重要因素的重要性。