Evidence-based practice: What do undergraduate health students think it means?
Introduction: Evidence-based practice (EBP) is a client-centred, collaborative process of enquiry, evidence gathering and critical reasoning to facilitate defensible healthcare decisions. Developing EBP competence in health students starts with ensuring that they understand what EBP means. This study explored the meanings undergraduate health students ascribe to EBP and investigated whether their understandings differ based on year level or discipline.
Methods: An online survey of undergraduate students in 20 health degree courses included the open-ended question “What does EBP mean to you?” Druckman’s (2005) method of content analysis, using both etic and emic categories, was used to analyse the students’ responses.
Results: Only 377 (two thirds) of the 584 students who submitted the survey provided an answer to the question; approximately half of those in their first year and three quarters of those in their final year answered the question. Most responses demonstrated a very limited understanding of the meaning of EBP. Differences in EBP conceptualisations based on year level and discipline were negligible.
Conclusions: Across the sample subgroups, the majority of students in this study demonstrated a narrow understanding of EBP, largely devoid of the processes or principles that EBP scholars espouse. For EBP to achieve its full potential, undergraduate health students may require frequent and explicit exposure to all five steps of the EBP process. If new graduates do not understand EBP to be a contextualised, collaborative process, there is a risk that the potential value of EBP will continue to be compromised.
Adams, K. B., Matto, H. C., & LeCroy, C. W. (2009). Limitations of evidence-based practice for social work education: Unpacking the complexity. Journal of Social Work Education, 45(2), 165–186. doi:10.5175/JSWE.2009.200700105
Albarqouni, L., Hoffmann, T., Straus, S., Olsen, N. R., Young, T., Ilic, D., . . . Glasziou, P. (2018). Core competencies in evidence-based practice for health professionals: Consensus statement based on a systematic review and delphi survey. JAMA Network Open, 1(2), 180281–180281.
Bennett, S., Hoffmann, T., & Arkins, M. (2011). A multi‐professional evidence‐based practice course improved allied health students' confidence and knowledge. Journal of Evaluation in Clinical Practice, 17(4), 635–639.
Berg, H., & Slaattelid, R. (2017). Facts and values in psychotherapy: A critique of the empirical reduction of psychotherapy within evidence-based practice. Journal of Evaluation of Clinical Practice, 23(5), 1075–1080. doi:10.1111/jep.12739
Carnwell, R. (2000). Essential differences between research and evidence-based practice. Nurse Researcher, 8(2), 55. doi:10.7748/nr2001.01.8.2.55.c6150
Charania, N., Ross‐Durow, P., Sullivan, B., & Danse, L. (2018). Designing assignments to establish a foundation for evidence‐based practice in an undergraduate clinical nursing course. Worldviews on Evidence-Based Nursing, 15(2), 149–151. doi:10.1111/wvn.12198
Clyde, J. H., Brooks, D., Cameron, J. I., & Salbach, N. M. (2016). Validation of the evidence-based practice confidence (EPIC) scale with occupational therapists. The American Journal of Occupational Therapy, 70(2). doi:10.5014/ajot.2016.017061
Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K., . . . Osborne, J. (2005). Sicily statement on evidence-based practice. BMC Medical Education, 5(1), 1–7. doi:10.1186/1472-6920-5-1
DeCuir-Gunby, J. T., Marshall, P. L., & McCulloch, A. W. (2011). Developing and using a codebook for the analysis of interview data: An example from a professional development research project. Field Methods, 23(2), 136–155. doi:10.1177/1525822X10388468
Djulbegovic, B., & Guyatt, G. H. (2017). Progress in evidence-based medicine: A quarter century on. Lancet, 390(10092), 415–423. doi:10.1016/s0140-6736(16)31592-6
Drisko, J. (2017). Active collaboration with clients: An underemphasized but vital part of evidence-based practice. Social Work, 62(2), 114–121. doi:10.1093/sw/swx003
Drisko, J. W., & Maschi, T. (2016). Content analysis. New York, NY: Oxford University Press.
Druckman, D. (2005). Content analysis. In D. Druckman (Ed.), Doing research (pp. 257–275). Thousand Oaks, CA: SAGE. doi:10.4135/9781412983969
Engebretson, J., Mahoney, J., & Carlson, E. (2008). Cultural competence in the era of evidence-based practice. Journal of Professional Nursing, 24(3), 172–178. doi:10.1016/j.profnurs.2007.10.012
Estabrooks, C. A., Floyd, J. A., Scott-Findlay, S., O'Leary, K. A., & Gushta, M. (2003). Individual determinants of research utilization: A systematic review. Journal of Advanced Nursing, 43(5), 506–520.
Fiset, V. J., Graham, I. D., & Davies, B. L. (2017). Evidence-based practice in clinical nursing education: A scoping review. The Journal of Nursing Education, 56(9), 534–541. doi:10.3928/01484834-20170817-04
Goodman, R. A., Boyd, C., Tinetti, M. E., Kohorn, I. V., Parekh, A. K., & McGinnis, J. M. (2014). IOM and DHHS meeting on making clinical practice guidelines appropriate for patients with multiple chronic conditions. Annals of Family Medicine, 12(3), 256–259. doi:10.1370/afm.1646
Grady, M., & Drisko, J. (2014). Thorough clinical assessment: The hidden foundation of evidence-based practice. Families in Society: The Journal of Contemporary Social Services, 95(1), 5–14. doi:10.1606/1044-3894.2014.95.2
Harding, E. K., Porter, F. J., Horne-Thompson, F. A., Donley, F. E., & Taylor, F. N. (2014). Not enough time or a low priority? Barriers to evidence-based practice for allied health clinicians. Journal of Continuing Education in the Health Professions, 34(4), 224–231. doi:10.1002/chp.21255
Harvey, G., & Kitson, A. (2015). Translating evidence into healthcare policy and practice: Single versus multi-faceted implementation strategies. Is there a simple answer to a complex question? [Editorial]. International Journal of Health Policy and Management, 4(3), 123. doi:10.15171/ijhpm.2015.54
Hasnain-Wynia, R. (2006). Is evidence-based medicine patient-centered and is patient-centered care evidence-based? Health Services Research, 41(1), 1–8. doi:10.1111/j.1475-6773.2006.00504.x
Hitch, D., & Nicola-Richmond, K. (2017). Instructional practices for evidence-based practice with pre-registration allied health students: A review of recent research and developments. Advances in Health Sciences Education, 22(4), 1031–1045. doi:10.1007/s10459-016-9702-9
Hoffmann, T., Bennett, S., & Del Mar, C. (2017). Introduction to evidence-based practice. In T. Hoffman, S. Bennett, & C. Del Mar (Eds.), Evidence-based practice across the Health Professions (3rd ed.) (pp. 1–15). Chatswood, NSW, Australia: Elsevier.
Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R., & Stewart, R. (2011). Teaching critical appraisal skills in healthcare settings. Cochrane Database of Systematic Reviews, 2011(11), CD001270. doi:10.1002/14651858.CD001270.pub2.
Ioannidis, J. P. A. (2016). Evidence-based medicine has been hijacked: A report to David Sackett. Journal of Clinical Epidemiology, 73, 82–86. doi: 10.1016/j.jclinepi.2016.02.012
Johnston, J. M., Leung, G. M., Fielding, R., Tin, K. Y. K., & Ho, L. M. (2003). The development and validation of a knowledge, attitude and behaviour questionnaire to assess undergraduate evidence-based practice teaching and learning. Medical Education, 37(11), 992–1000. doi:10.1046/j.1365-2923.2003.01678.x
Leung, K., Trevena, L., & Waters, D. (2018). Content validation of the evidence-based nursing practice assessment tool. Nurse Researcher, 26(1), 33–40. doi:10.7748/nr.2018.e1544
Malik, G., McKenna, L., & Griffiths, D. (2017). Using pedagogical approaches to influence evidence-based practice integration: Processes and recommendations. Findings from a grounded theory study. Journal of Advanced Nursing, 73(4), 883–893. doi:10.1111/jan.13175
Meisel, Z., & Karlawish, J. (2011). Narrative vs evidence-based medicine: And, not or. JAMA, 306(18), 2022–2023. doi:10.1001/jama.2011.1648
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51. Retrieved from http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/NCNJ/A/NCNJ_165_516_2010_08_23_DGSODKGNM_1651_SDC516.pdf
Mullen, E. J., & Streiner, D. L. (2004). The evidence for and against evidence-based practice. Brief Treatment and Crisis Intervention, 4(2), 111–121. doi:10.1093/brief-treatment/mhh009
Murphy, K., Guisard, Y., Curtin, M., Thomas, C., Crawford, R., & Biles, J. (2018). Impact of the learning context on undergraduate healthcare students’ evidence-based practice confidence and attitudes. Health Education in Practice: Journal of Research for Professional Learning, 1(1), 32–50. Available at https://openjournals.library.sydney.edu.au/index.php/HEP/article/view/12509
Murphy, K., Parnell, T., Pope, R., Hughes, C., Biles, J., Bramble, M., . . . Plowman, E. (2019). Improving evidence-based practice education in healthcare courses: A participatory action research multiple-case study. In Proceedings of the 5th International Conference on Higher Education Advances (pp. 605–614). Valencia, Spain: Universitat Politecnica de Valencia. doi:10.4995/HEAd19.2019.9152
O'Halloran, P., Porter, S., & Blackwood, B. (2010). Evidence based practice and its critics: What is a nurse manager to do? [Report]. Journal of Nursing Management, 18(1), 90–95.
Oxford Centre for Evidence-Based Medicine (OCEBM). (2011). The Oxford 2011 levels of evidence. Retrieved from http://www.cebm.net/index.aspx?o=5653
Patelarou, A. E., Kyriakoulis, K. G., Stamou, A. A., Laliotis, A., Sifaki-Pistolla, D., Matalliotakis, M., . . . Patelarou, E. (2017). Approaches to teach evidence-based practice among health professionals: An overview of the existing evidence. Advances in Medical Education and Practice, 2017(8), 455–464. doi:10.2147/AMEP.S134475
Patterson-Silver Wolf, D. A., Dulmis, C. N., & Maguin, E. (2012). Empirically supported treatment’s impact on organizational culture and climate. Research on Social Work Practice, 22(6), 665–671. doi:10.1177/1049731512448934
Rousseau, D. M., & Gunia, B. C. (2016). Evidence-based practice: The psychology of EBP implementation. Annual Review of Psychology, 67(1), 667–692. doi:10.1146/annurev-psych-122414-033336
Rubin, A. (2012). Practitioner's guide to using research for evidence-based practice (2nd ed.). Hoboken, NJ: Wiley.
Rubin, A. (2015). Evidence-based practice empowers practitioners: A response to Epstein. Research on Social Work Practice, 25(4), 507–509. doi:10.1177/1049731514543666
Ruzafa-Martínez, M., López-Iborra, L., Barranco, D. A., & Ramos-Morcillo, A. J. (2016). Effectiveness of an evidence-based practice (EBP) course on the EBP competence of undergraduate nursing students: A quasi-experimental study. Nurse Education Today, 38, 82–87.
Salbach, N. M., & Jaglal, S. B. (2011). Creation and validation of the evidence-based practice confidence scale for health care professionals. Journal of Evaluation in Clinical Practice, 17(4), 794–800. doi:10.1111/j.1365-2753.2010.01478.x
Saunders, H., Gallagher‐Ford, L., Kvist, T., & Vehviläinen‐Julkunen, K. (2019). Practicing healthcare professionals’ evidence‐based practice competencies: An overview of systematic reviews. Worldviews on Evidence‐Based Nursing, 16, 176–185. doi:10.1111/wvn.12363
Schatzki, T. R. (2002). The site of the social: A philosophical account of the constitution of social life and change. University Park, PA: Pennsylvania State University Press.
Skeat, J. (2013). Using grounded theory in health research. In P. Liamputtong (Ed.), Research methods in health: Foundations for evidence based practice (2nd ed.) (pp. 100–109). Melbourne, Australia: Oxford University Press.
Snibsøer, A. K., Graverholt, B., Nortvedt, M. W., Riise, T., & Espehaug, B. (2018). Evidence-based practice profiles among bachelor students in four health disciplines: A cross-sectional study. BMC Medical Education, 18(1). doi:10.1186/s12909-018-1319-7
Swinkels, A., Albarran, J. W., Means, R. I., Mitchell, T., & Stewart, M. C. (2002). Evidence-based practice in health and social care: Where are we now? Journal of Interprofessional Care, 16(4), 335–347. doi:10.1080/1356182021000008265
Tanner, C. A. (2008). Clinical judgment and evidence-based practice: Toward pedagogies of integration. Journal of Nursing Education, 47(8), 335–336.
Towns, E., & Ashby, S. (2014). The influence of practice educators on occupational therapy students’ understanding of the practical applications of theoretical knowledge: A phenomenological study into student experiences of practice education. Australian Occupational Therapy Journal, 61(5), 344–352. doi:10.1111/1440-1630.12134
Verloo, H., Desmedt, M., & Morin, D. (2017). Beliefs and implementation of evidence‐based practice among nurses and allied healthcare providers in the Valais hospital, Switzerland. Journal of Evaluation in Clinical Practice, 23(1), 139–148. doi:10.1111/jep.12653
Wall, S. (2008). A critique of evidence-based practice in nursing: Challenging the assumptions. Social Theory & Health, 6(1), 37–53. doi:10.1057/palgrave.sth.8700113
Westwater-Wood, S., Hendrick, P., & Diver, C. (2014). Can “evidence based practice” be taught in a way that is meaningful to the student for practice? Health and Social Care Education, 3(1), 44–45. doi:10.11120/hsce.2013.00037
Willis, J. W. (2007). Foundations of qualitative research: Interpretive and critical approaches. Thousand Oaks, CA: Sage.
Zwolsman, S. E., van Dijk, N., te Pas, E., & Wieringa-de Waard, M. (2013). Barriers to the use of evidence-based medicine: Knowledge and skills, attitude, and external factors. Perspectives on Medical Education, 2(1), 4–13.
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