الفهرس 
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Abstract
Summary
Evidence-based medicine (EBM) is the process of identifying and assessing the best available scientific evidence and integrating this evidence with the clinician’s judgment and the patient’s values to make medical decisions.
Evidence-based medicine has emerged as a new paradigm for medical practice. It involves integrating individual clinical expertise with the best available external clinical evidence and the usage of individual patients’ rights and preferences in making clinical decisions about their care. Awareness of the latest scientific evidence and the ability to critically appraise literature and assess its applicability has been identified as integral to the practice of EBM.
This study is an interventional study. It aimed to study the change in knowledge, attitude &practice of evidence based medicine among physicians (residents, demonstrators& assistant lecturers) working at Benha University hospitals after application of the educational program.
Collection of data was conducted on 3 stages:1st stage to measure knowledge , attitude & practice toward evidence based medicine from physicians before application of the educational program.2nd stage: conduction of the educational program.3rd stage: to measure the change in physician’s evidence based medicine knowledge , attitude & practice after implementation of medical education program, using the questionnaire used in phase one.
Two hundred and sixty questionnaires were distributed to get 220 completed questionnaires and the incomplete one was discarded from the analysis. The physicians who didn’t complete the questionnaire were mainly residents but not belonged to certain specialty and this was due to work overload on junior staff. A standard questionnaire adopted from (McColl et al., 1998).
The awareness about EBM among physicians increased post program78.2%. More than fifty percentage of physicians became aware about different EBM resources after the intervention program as, BMJ publishing group accounted for65.9% , pubmed 64.5%, , family practice journal 59%& clinical evidence journal56.4% .
Highest percentage of awareness was among assistant lecturers for BMJ publishing group and family practice journal( 74% & 70.5% respectively).Physicians grades had a significant effect on awareness of EBM resources. There are no statistical significant differences between different specialties as regard knowledge of EBM resources. There was a statistically significant difference between knowledge score before and after the application of the educational program .
Regarding physicians attitudes towards EBM compared by grade and specialty, majority of residents, demonstrators and assistant lecturers were comparable regarding having positive attitudes towards EBM. A significance difference was observed in their positive attitude toward current EBM promotion ,being highest among physicians of int medicine and surgical departments accounting for (86.9% and 70.6% post program) respectively. There were statistically significant correlation between age of physicians and knowledge; attitude score .
The percentage of physicians that attend courses in EBM and critical appraisal increase after application of the educational program 24.5% &14.5% respectively. No significant difference was observed in using WWW search to make influence on clinical practice before and after application of the interventional program(69.1%&72.9%respectively).More than 80% of physicians reported reading medical journal (82.4% before &86.4% after the program.
There was general agreement about the educational methods to move toward EBM practices with the highest percentage 83.2%&88.2% for EBM integration in the undergraduate course, followed by workshops for training physicians 67.3%&76.4% then case review held in each department 67.3%& 75.5% pre and post program respectively.
In the present study the physicians mentioned different sources of information that they used when they facing problems during patient management . Verbal consultation from senior staff was(68.6% pre &79.7%) post program, reading Textbooks and handbooks accounted for(68.6% pre&75% post program). Those methods were the commonest methods used by physicians to solve clinical problems during patient management .The least to be used was searching on the internet method (29.6% pre& 37.3% post program).
After application of the interventional program, higher percentage of participants57% reported that they don’t believe in EBM as a barrier than had done so before 51% as they complained that doctor experience is considered of no value compared with evidence based facts. This difference was not statistically significant. There were a decrease in proportion of physicians reported insufficient resources(92.9% pre&81.4%post program), Lack of skills(91.1% pre&82.6% post program), lack of time(91.1%pre &79.7% post program)and patient overload (87.5% pre &74.4% post program) as barriers to practice EBM , as they became aware of advantages of practice EBM.
conclusion: after application of the educational program knowledge of evidence-based practice improved markedly with a targeted educational intervention. Physicians attitude towards EBM was positive before and after application of the program. However, changes in practice were small, based on the frequency of searching and appraisal activities. They need more teaching and training to ensure they correct application of EBM in their daily patient care, these training and application should be integrated in both undergraduate and postgraduate courses take into consideration the barriers that mentioned by them and interfere with their use of EBM.