Evidence-based medicine training and implementation in surgery: the role of surgical cultures

Authors

  • Simon Kitto PhD,

    Corresponding author
    1. Scientist, Li Ka Shing Knowledge Institute, St. Michael's Hospital and The Wilson Centre for Research in Education, Faculty of Medicine, University of Toronto; Assistant Professor in the Department of Surgery, Faculty of Medicine, University of Toronto; Director of Research, Office of Continuing Education and Professional Development, Faculty of Medicine, University of Toronto and Senior Lecturer (Adjunct), Department of Surgery, Monash University, Melbourne, Victoria, Australia
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  • Ana Petrovic BSc,

    1. Adjunct Junior Research Associate in the Department of Surgery (MMC) Monash Medical Centre, Monash University, Southern Health, Monash Medical Centre, Clayton, Victoria, Australia
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  • Russell L. Gruen MBBS PhD FRACS,

    1. Professor of Surgery and Public Health, National Trauma Research Institute, Alfred Hospital, Monash University, Melbourne, Victoria, Australia
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  • Julian A. Smith MBBS MS FRACS FACS FCSANZ

    1. Professor and Head, Department of Surgery, Monash Medical Centre, Monash University, Southern Health, Monash Medical Centre, Clayton, Victoria, Australia
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Dr Simon Kitto, Li Ka Shing Knowledge Institute of SMH, c/o Winnie Yau, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. E-mail: simon.kitto@utoronto.ca

Abstract

Purpose  This qualitative study identifies cultural factors that influence the effective implementation of evidence-based medicine (EBM) in surgical practice among Australian surgeons.

Methods  In-depth interviews (n = 22) were conducted with surgeons from a variety of specialties within a large hospital system in Victoria, Australia. The interviews explored the surgeons' understanding of EBM; and challenges to the adoption of EBM. The canons and procedures of the Miles and Huberman's Matrix Analyses approach to qualitative research guided the coding and organization of the data derived from the semi-structured interviews.

Results  Surgeons had a good understanding of EBM, but viewed it as little more than a system of evidence, which was often divorced from actual clinical practice. The data also suggested that surgical culture(s) and typologies of surgical style were important variables in the implementation of EBM. The results suggest that the ideal method of EBM implementation is workplace instruction led by surgeons, who exhibit scientist and/or clinician styles of surgical practice; EBM training should occur early in the surgeons' careers; and EBM practice should be role modelled in the presence of trainees by surgeons who exhibit either a scientist and/or clinician style of surgical practice.

Conclusions  The study findings suggest that using pre-existing surgical culture(s) and styles is an important component in the implementation of EBM in surgery. The effective use of the scientist and/or clinician surgeon within the apprenticeship model and the context-specific collegial networks of the surgical profession appear to be key elements in ensuring the successful implementation of EBM in surgery.

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