Shehata Gihan M, Zaki Adel, Dowidar Nabil L, El Sayed Iman
Departments of aBiomedical Informatics and Medical Statistics bExperimental and Clinical Surgery, Medical Research Institute, Alexandria, Egypt.
J Egypt Public Health Assoc. 2015 Sep;90(3):115-20. doi: 10.1097/01.EPX.0000470848.07476.f9.
Evidence-based practice is important for developing countries and is expected to thrive in a questioning culture. Experienced physicians differ in the making of clinical judgements, which are often not based on evidence. Although this topic is of paramount importance to the quality of care provided in the university hospitals in Alexandria, little research has been done about attitudes towards evidence-based medicine (EBM), and the extent of physicians' skills to access and interpret evidence.
This study aimed to investigate the relation between the attitude towards EBM and the indicators for questioning mind and critical appraisal skills among physicians in Alexandria, Egypt.
In a cross-sectional study, physicians (N=549) were randomly selected from different clinical departments in three of the university hospitals in Alexandria, Egypt using the stratified proportionate random sampling technique. A self-administrated questionnaire modified from the questionnaire used by McColl and colleagues was used.
A high percentage of physicians (83%) had positive attitude towards EBM. Feeling knowledge gap every day was reported by 34.2% of the physicians while 55.6% felt knowledge gap less frequently. The percentage of physicians who understood the meaning of different measures used to assess the importance of results and quality of evidence in meta-analysis studies ranged from 10.8 to 24.2%. Higher frequency of feeling knowledge gap in clinical practice and the ability to correctly answer different questions reflecting critical reading skills were all significantly associated with positive attitude towards EBM (P<0.05). A significant association (P<0.05) was also found between the frequency of feeling knowledge gap and the ability to answer questions related to critical reading of literature.
This study has identified a significant relation between critical thinking skills and having a positive attitude towards EBM among physicians in the university hospitals in Alexandria. The study supported the hypothesis that strategies that encouraging critical thinking in medical education could improve the attitude of physicians towards EBM. Adopting teaching methods that encourage critical thinking in medical education as well as including the concepts and principals of critical appraisal of scientific research in the syllabus of both undergraduate and postgraduate medical students are recommended.
循证医学实践对发展中国家很重要，且有望在质疑文化中蓬勃发展。经验丰富的医生在临床判断的形成上存在差异，这些判断往往并非基于证据。尽管该话题对亚历山大港大学医院所提供护理的质量至关重要，但关于对循证医学（EBM）的态度以及医生获取和解读证据的技能程度的研究却很少。
本研究旨在调查埃及亚历山大港医生对循证医学的态度与质疑思维及批判性评估技能指标之间的关系。
在一项横断面研究中，采用分层比例随机抽样技术，从埃及亚历山大港三所大学医院的不同临床科室中随机选取了549名医生。使用了一份根据麦科尔及其同事所使用的问卷修改而来的自填式问卷。
高比例的医生（83%）对循证医学持积极态度。34.2%的医生表示每天都感觉知识有差距，而55.6%的医生感觉知识差距的频率较低。理解用于评估荟萃分析研究中结果重要性和证据质量的不同测量方法含义的医生比例在10.8%至24.2%之间。临床实践中感觉知识差距的频率较高以及正确回答反映批判性阅读技能的不同问题的能力，均与对循证医学的积极态度显著相关（P<0.05）。在感觉知识差距的频率与回答与文献批判性阅读相关问题的能力之间也发现了显著关联（P<0.05）。
本研究确定了亚历山大港大学医院医生的批判性思维技能与对循证医学持积极态度之间存在显著关系。该研究支持了这样的假设，即医学教育中鼓励批判性思维的策略可以改善医生对循证医学的态度。建议采用在医学教育中鼓励批判性思维的教学方法，并将科研批判性评估的概念和原则纳入本科和研究生医学生的教学大纲。
