title: Perceptions and competence in evidence-based medicine: Are surgeons getting better? A questionnaire survey of members of the Dutch Orthopaedic Association.
abstract: BACKGROUND
  The Journal of Bone and Joint Surgery, American Volume (The Journal) recently initiated a section called "Evidence-Based Orthopaedics." Furthermore, a level-of-evidence rating is now used in The Journal to help readers in clinical decision-making. Little is known about whether this recent emphasis has influenced surgeons' perceptions about and competence in evidence-based medicine. Therefore, we examined perceptions and competence in evidence-based medicine among Dutch orthopaedic surgeons.
  
  
  METHODS
  Members of the Dutch Orthopaedic Association were surveyed to examine their attitudes toward evidence-based medicine and their competence in evidence-based medicine. We evaluated competences using a newly developed instrument tailored to surgical practice.
  
  
  RESULTS
  Of the 611 members, 367 surgeons (60%) responded. Orthopaedic surgeons welcomed evidence-based medicine. Practical evidence-based medicine resources were perceived as the best method to move from opinion-based or experience-based to evidence-based practice. Four variables were significantly and positively associated with the competence instrument: (1) a younger age, particularly between thirty-six and forty-five years (p = 0.007), (2) experience of less than ten years (p = 0.032), (3) having a PhD degree (p < 0.001), and (4) working in an academic or teaching setting (p = 0.004). The majority of the respondents were aware of The Journal's evidence-based medicine section (84%) and level-of-evidence ratings (65%), and 20% used The Journal's evidence-based medicine abstracts in clinical decision-making. This increased awareness of evidence-based medicine was also reflected in the frequent use of Cochrane reviews in clinical decision-making (27% of the respondents). Surgeons who used and those who were aware of but did not use The Journal's evidence-based medicine abstracts or Cochrane reviews in clinical decision-making had significantly higher competence instrument scores than those who were unaware of these resources (p = 0.03 and p < 0.001, respectively).
  
  
  CONCLUSIONS
  Evidence-based medicine is welcomed by Dutch orthopaedic surgeons. The recent emphasis on evidence-based medicine is reflected in an increased awareness about The Journal's evidence-based medicine section, levels of evidence, and the largest evidence-based medicine resource: the Cochrane reviews. Younger orthopaedic surgeons had better knowledge about evidence-based medicine. The development and use of evidence-based resources as well as preappraised summaries such as The Journal's evidence-based medicine abstracts and Cochrane reviews were perceived as the best way to move from opinion-based to evidence-based orthopaedic practice.
authors.affiliation: Division of Orthopaedic Surgery, McMaster University, Hamilton General Hospital, 7 North, Room 727, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada. poolman@trauma.nl
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
authors.forename: Inger N
authors.initials: IN
authors.lastname: Sierevelt
authors.forename: Forough
authors.initials: F
authors.lastname: Farrokhyar
authors.forename: J Adriaan
authors.initials: JA
authors.lastname: Mazel
authors.forename: Leendert
authors.initials: L
authors.lastname: Blankevoort
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003625:Data Collection; D019317:Evidence-Based Medicine; D006801:Humans; D008875:Middle Aged; D009426:Netherlands; D009985:Orthopedics; D012955:Societies, Medical / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires