International Web Survey of Chiropractic Students About Evidence-based Practice: A Pilot Study

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SOURCE:   Chiropractic & Manual Therapies 2011 (Mar 3); 19 (1): 6

Ryunosuke Banzai, Dustin C Derby, Cynthia R Long
and Maria A Hondras

Palmer Center for Chiropractic Research,
Palmer College of Chiropractic,
741 Brady Street, Davenport, IA 52803-5209, USA.

BACKGROUND:   Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles.

METHODS:   We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis.

RESULTS:   Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9).

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CONCLUSIONS:   Although it is feasible to conduct an international web survey of chiropractic students, significant stakeholder participation is important to improve response rates. Students had relatively positive attitudes toward EBP. However, participants felt they needed more training in EBP and based on the knowledge questions they may need further training about basic research concepts.


From the Full-Text Article:


Since the early 1990’s when the Evidence-Based Medicine Working Group at McMaster University [1] established explicit methodologies to determine “best evidence” for clinical medicine, many professional groups and organizations have emphasized the importance of evidence-based practice (EBP) for their practitioners. [2–6] The EBP movement emerged to facilitate clinical decision-making by healthcare professionals and their patients; however, both groups are challenged to know how, where, and when to seek out the best evidence to bridge gaps between research evidence and practical health outcomes. [7]

Djulbegovic et al. [8] recently stated that “we should regard evidence-based medicine as a constantly evolving heuristic foundation for optimizing clinical practice, rather than a new scientific or philosophical theory that changes the nature of medicine.”   By virtue of the exponential growth of healthcare information of both high and low quality, acquisition of EBP principles requires certain knowledge and skills to synthesize the best available research evidence with other factors in clinical decision-making. [9, 10]

There are a number of ways available to deal with the difficulties and barriers of teaching EBP principles [11–18] and exposure to EBP principles in healthcare education has received considerable attention during the past decade. [5, 19–23] The Accreditation Council for Graduate Medical Education [5] requires medical residents to demonstrate the ability to appraise and to integrate scientific evidence. Similarly, an understanding of the principles of EBP and the application of evidence into practice is part of the core training both of medical doctors and complementary and alternative medicine (CAM) healthcare practitioners in the United Kingdom. [6] Smith et al. [23] stated that the development of “evidence-based skills” should include early exposure and experience with fundamental literature searching and critical appraisal skills. Novice clinicians may then develop critical thinking skills and learn to apply those skills to clinical decision-making. Because scientific evidence application plays such a critical role in the clinical decision-making process, healthcare students should learn and implement best practices using EBP during their professional course of study. Chiropractic, one of the most widely used CAM disciplines, [24] is no exception.

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