Department of General Practice/Family Medicine, Academic Medical Center-University of Amsterdam, The Netherlands.
Acad Med. 2010 Jul;85(7):1163-70. doi: 10.1097/ACM.0b013e3181d4152f.
Insufficient time and lack of skills are important barriers to the practice of evidence-based medicine (EBM). Residents could have additional barriers because their practice can be strongly influenced by the educational system and clinical supervisors. The purpose of this study, therefore, was to systematically appraise and summarize the literature on the barriers that residents experience in the application of EBM in daily practice.
The authors searched MEDLINE, EMBASE, the Cochrane Library, CINAHL, and ERIC for publications preceding January 2008. Additionally, they manually screened the abstracts of relevant conferences (Association for Medical Education in Europe, Society of General Internal Medicine, Society of Medical Decision Making, Ottawa, and Evidence-Based Health Care Teachers & Developers) from January 2001 until January 2008. The search was extended by contacting experts in the field. Original studies on barriers to applying EBM in daily practice were included. Methodological quality was assessed and results were extracted by two reviewers using prespecified forms.
The search resulted in 511 titles, 84 abstracts, and 3 studies suggested by experts, of which 9 were included in this review. The quality of the included studies was high. The most frequently mentioned barriers for residents were limited available time (28%-85%), attitude, and knowledge and skills. In four studies, specific barriers related to the position of residents, such as influences from staff members, lack of experience in EBM, and low possibilities to change conditions, were described.
Residents experience specific barriers to practice EBM. These barriers should be recognized and integrated into EBM training programs for residents.
时间不足和技能缺乏是实践循证医学（EBM）的重要障碍。由于其实践可能受到教育系统和临床主管的强烈影响，住院医师可能会遇到其他障碍。因此，本研究的目的是系统地评价和总结有关住院医师在日常实践中应用 EBM 时所面临障碍的文献。
作者检索了 MEDLINE、EMBASE、Cochrane 图书馆、CINAHL 和 ERIC，以获取 2008 年 1 月之前的出版物。此外，他们还手动筛选了 2001 年 1 月至 2008 年 1 月期间相关会议（欧洲医学教育协会、普通内科医师学会、医学决策制定学会、渥太华循证医疗保健教师和开发者协会）的摘要。通过联系该领域的专家，对搜索进行了扩展。纳入了关于在日常实践中应用 EBM 的障碍的原始研究。两名审查员使用预定表格评估方法学质量并提取结果。
搜索结果产生了 511 个标题、84 个摘要和专家建议的 3 项研究，其中 9 项研究被纳入本综述。纳入研究的质量很高。住院医师最常提到的障碍是可用时间有限（28%-85%）、态度以及知识和技能。在四项研究中，描述了与住院医师职位相关的特定障碍，例如来自工作人员的影响、缺乏 EBM 经验以及改变条件的可能性低。
住院医师在实践 EBM 时会遇到特定的障碍。这些障碍应被认识到，并纳入住院医师的 EBM 培训计划中。
