title: Doctors' perceptions and use of evidence-based medicine: a systematic review and thematic synthesis of qualitative studies.
abstract: OBJECTIVE
  Many primary qualitative studies of barriers and facilitators for doctors' use of evidence-based medicine (EBM) are available, but knowledge remains fragmented. This study sought to synthesize the results of these qualitative studies, taking the variability across context (i.e., medical disciplines, career stages, practice settings, and time of study) into account.
  
  
  METHODS
  The authors searched PubMed through April 26, 2012, and independently selected studies according to prespecified criteria for relevance and methodological quality. Additionally, they performed a thematic synthesis through line-by-line interpretation, coding, and thematic arrangement of information.
  
  
  RESULTS
  The search resulted in 1,211 publications, of which 30 studies were included. Five major themes emerged on barriers and facilitators for doctors' use of EBM: individual mind-set, professional group norms, EBM competencies, balance between confidence and critical reflection, and managerial collaboration. The authors found particular barriers and facilitators across career stages. Although clinical experience and professional status were perceived to be helpful, they could also prevent doctors from identifying information needs and adopting new evidence. Although residents' lack of clinical experience raised awareness of information needs, residents perceived lack of clinical experience and their hierarchical dependence on staff as barriers to articulating information needs and to translating and introducing evidence to patient care.
  
  
  CONCLUSIONS
  Encouragement of group norms for safe communication and shared learning across career stages is perceived as the most prominent facilitator for EBM.
authors.affiliation: Department of Clinical Epidemiology, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. maartjeswennen@gmail.com
authors.forename: Maartje H J
authors.initials: MH
authors.lastname: Swennen
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Hennie R
authors.initials: HR
authors.lastname: Boeije
authors.forename: Nanda
authors.initials: N
authors.lastname: van Rheenen
authors.forename: Floor J M
authors.initials: FJ
authors.lastname: Verheul
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Cor J
authors.initials: CJ
authors.lastname: Kalkman
mesh_terms: D001291:Attitude of Health Personnel; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D006801:Humans; D010820:Physicians; D017410:Practice Guidelines as Topic; D036301:Qualitative Research