title: Critical thinking and attitude of physicians toward evidence-based medicine in Alexandria, Egypt.
abstract: BACKGROUND
  Evidence-based practice is important for developing countries and is expected to thrive in a questioning culture. Experienced physicians differ in the making of clinical judgements, which are often not based on evidence. Although this topic is of paramount importance to the quality of care provided in the university hospitals in Alexandria, little research has been done about attitudes towards evidence-based medicine (EBM), and the extent of physicians' skills to access and interpret evidence.
  
  
  OBJECTIVE
  This study aimed to investigate the relation between the attitude towards EBM and the indicators for questioning mind and critical appraisal skills among physicians in Alexandria, Egypt.
  
  
  METHODS
  In a cross-sectional study, physicians (N=549) were randomly selected from different clinical departments in three of the university hospitals in Alexandria, Egypt using the stratified proportionate random sampling technique. A self-administrated questionnaire modified from the questionnaire used by McColl and colleagues was used.
  
  
  RESULTS
  A high percentage of physicians (83%) had positive attitude towards EBM. Feeling knowledge gap every day was reported by 34.2% of the physicians while 55.6% felt knowledge gap less frequently. The percentage of physicians who understood the meaning of different measures used to assess the importance of results and quality of evidence in meta-analysis studies ranged from 10.8 to 24.2%. Higher frequency of feeling knowledge gap in clinical practice and the ability to correctly answer different questions reflecting critical reading skills were all significantly associated with positive attitude towards EBM (P<0.05). A significant association (P<0.05) was also found between the frequency of feeling knowledge gap and the ability to answer questions related to critical reading of literature.
  
  
  CONCLUSIONS
  This study has identified a significant relation between critical thinking skills and having a positive attitude towards EBM among physicians in the university hospitals in Alexandria. The study supported the hypothesis that strategies that encouraging critical thinking in medical education could improve the attitude of physicians towards EBM. Adopting teaching methods that encourage critical thinking in medical education as well as including the concepts and principals of critical appraisal of scientific research in the syllabus of both undergraduate and postgraduate medical students are recommended.
authors.affiliation: Departments of aBiomedical Informatics and Medical Statistics bExperimental and Clinical Surgery, Medical Research Institute, Alexandria, Egypt.
authors.forename: Gihan M
authors.initials: GM
authors.lastname: Shehata
authors.forename: Adel
authors.initials: A
authors.lastname: Zaki
authors.forename: Nabil L
authors.initials: NL
authors.lastname: Dowidar
authors.forename: Iman
authors.initials: I
authors.lastname: El Sayed
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004534:Egypt; D019317:Evidence-Based Medicine; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013850:Thinking