Actually turning the fascinating discussions you all have (I’m sure) over breakfast, beer or bovril about the latest systematic reviews, touching on all elements of critical appraisal from their complex search to their use of mixed logistic regression meta-analysis into action is, sometimes, difficult. We all stop on our course from asking questions, through acquiring information, and appraising that evidence, before we hit the application of our knowledge in practice. But why and does it vary?
In a nice paper from a team which scoured an international panel of self-confessed EBMers alongside a complex systematic review of organisational and management psychology to ask about barriers and implementers for EBM a questionnaire for self-assessment of your own reasons why you do or don’t put EBM into practice. The questionnaire takes issue with a number of themes: your attitude to EBM – both as a philosophy and your own intent to ‘do’ EBM, the subjective understanding of the ‘norms’ of practice, the ability of someone to control and their own healthcare behaviours (like – can you change or do you need to do what you’re told).
Take your attitude to EBM – do you ‘have faith’ in it as a way forward? Do you intend to make your practice ‘evidence based’?
What are the ‘norms’ in your place of work – does your ward/unit/hospital “Do” EBM? Can you point to your key leaders and say they are EBMistas?
Can you do it – do you have confidence in your EBM skills? Do you have a micro-environment that lets you make decisions and change practice on evidence? How much of the way you make decisions is influenced by what your colleagues are doing, what the guidelines say should be done or what your understanding of the evidence is?
It’s very much worth having a think about these elements. They may help you identify areas for self-improvement, and for good explanations of why you feel constrained or frustrated. It may give you the direction in which to wheel your proddy stick of improvement …