Evidence-based medicine training and implementation in surgery: the role of surgical cultures.
OBJECTIVE
This qualitative study identifies cultural factors that influence the effective implementation of evidence-based medicine (EBM) in surgical practice among Australian surgeons.


METHODS
In-depth interviews (n = 22) were conducted with surgeons from a variety of specialties within a large hospital system in Victoria, Australia. The interviews explored the surgeons' understanding of EBM; and challenges to the adoption of EBM. The canons and procedures of the Miles and Huberman's Matrix Analyses approach to qualitative research guided the coding and organization of the data derived from the semi-structured interviews.


RESULTS
Surgeons had a good understanding of EBM, but viewed it as little more than a system of evidence, which was often divorced from actual clinical practice. The data also suggested that surgical culture(s) and typologies of surgical style were important variables in the implementation of EBM. The results suggest that the ideal method of EBM implementation is workplace instruction led by surgeons, who exhibit scientist and/or clinician styles of surgical practice; EBM training should occur early in the surgeons' careers; and EBM practice should be role modelled in the presence of trainees by surgeons who exhibit either a scientist and/or clinician style of surgical practice.


CONCLUSIONS
The study findings suggest that using pre-existing surgical culture(s) and styles is an important component in the implementation of EBM in surgery. The effective use of the scientist and/or clinician surgeon within the apprenticeship model and the context-specific collegial networks of the surgical profession appear to be key elements in ensuring the successful implementation of EBM in surgery.
Kitto
Simon
S
Li Ka Shing Knowledge Institute, St. Michael's Hospital and The Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto, Ontario, Canada. simon.kitto@utoronto.ca
Petrovic
Ana
A
Gruen
Russell L
RL
Smith
Julian A
JA
D000328:Adult; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine / Q000193:education*; D013502:General Surgery; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D014739:Victoria