Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence-Based Practice.
In recent years, evidence-based dentistry has become the ideal for research, academia, and clinical practice. However, barriers to implementation are many, including the complexity of interpreting conflicting evidence as well as difficulties in accessing it. Furthermore, many proponents of evidence-based care seem to assume that good evidence consistently exists and that clinicians can and will objectively evaluate data so as to apply the best evidence to individual patients' needs. The authors argue that these shortcomings may mislead many clinicians and that students should be adequately prepared to cope with some of the more complex issues surrounding evidence-based practice. Cognitive biases and heuristics shape every aspect of our lives, including our professional behavior. This article reviews literature from medicine, psychology, and behavioral economics to explore the barriers to implementing evidence-based dentistry. Internal factors include biases that affect clinical decision making: hindsight bias, optimism bias, survivor bias, and blind-spot bias. External factors include publication bias, corporate bias, and lack of transparency that may skew the available evidence in the peer-reviewed literature. Raising awareness of how these biases exert subtle influence on decision making and patient care can lead to a more nuanced discussion of addressing and overcoming barriers to evidence-based practice.
Dr. Coleman is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Johnson is Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Erley is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Topolski is in the Department of Psychological Sciences, Augusta University; Dr. Rethman is Adjunct Associate Professor, Baltimore College of Dental Surgery, University of Maryland and Adjunct Assistant Professor, College of Dentistry, The Ohio State University; and Dr. Lancaster is former Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia. Brandon.G.Coleman2.mil@mail.mil.
Brandon G
BG
Coleman
Dr. Coleman is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Johnson is Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Erley is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Topolski is in the Department of Psychological Sciences, Augusta University; Dr. Rethman is Adjunct Associate Professor, Baltimore College of Dental Surgery, University of Maryland and Adjunct Assistant Professor, College of Dentistry, The Ohio State University; and Dr. Lancaster is former Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia.
Thomas M
TM
Johnson
Dr. Coleman is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Johnson is Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Erley is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Topolski is in the Department of Psychological Sciences, Augusta University; Dr. Rethman is Adjunct Associate Professor, Baltimore College of Dental Surgery, University of Maryland and Adjunct Assistant Professor, College of Dentistry, The Ohio State University; and Dr. Lancaster is former Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia.
Kenneth J
KJ
Erley
Dr. Coleman is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Johnson is Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Erley is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Topolski is in the Department of Psychological Sciences, Augusta University; Dr. Rethman is Adjunct Associate Professor, Baltimore College of Dental Surgery, University of Maryland and Adjunct Assistant Professor, College of Dentistry, The Ohio State University; and Dr. Lancaster is former Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia.
Richard
R
Topolski
Dr. Coleman is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Johnson is Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Erley is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Topolski is in the Department of Psychological Sciences, Augusta University; Dr. Rethman is Adjunct Associate Professor, Baltimore College of Dental Surgery, University of Maryland and Adjunct Assistant Professor, College of Dentistry, The Ohio State University; and Dr. Lancaster is former Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia.
Michael
M
Rethman
Dr. Coleman is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Johnson is Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Erley is Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia; Dr. Topolski is in the Department of Psychological Sciences, Augusta University; Dr. Rethman is Adjunct Associate Professor, Baltimore College of Dental Surgery, University of Maryland and Adjunct Assistant Professor, College of Dentistry, The Ohio State University; and Dr. Lancaster is former Assistant Director, U.S. Army Advanced Education Program in Periodontics, Fort Gordon, Georgia.
Douglas D
DD
Lancaster
D015982:Bias; D004497:Education, Dental; D055094:Evidence-Based Dentistry; D007396:Internship and Residency; D017594:Publication Bias
bias; cognition; dental education; evidence-based dentistry; evidence-based practice; human performance factors