Justin Paulsen, Morhaf Al Achkar

Evidence-based medicine (EBM) plays a critical part in ensuring that practitioners use the soundest available medical procedures while avoiding ineffective ones. As such, it plays a key role in medical residency education. However, little research has shown what factors influence residents' adoption of habits in, self-efficacy in, and skills of EBM. This study gathered responses from a cross section of family medicine residents and new interns from 40 different residencies across the USA. The survey was based on Taylor et al's survey of EBM attitudes and behaviors and the Fresno test's assessment of EBM knowledge and skills. The study used negative binomial regression, ordinary least squares regression, and nonparametric tests of difference to assess the impact of residents' background (year in residency, type of residency, previous EBM training, and previous research experience) on these EBM outcomes. Residents with previous research experience are associated with stronger EBM habits, more self-efficacy in applying EBM, and greater ability in using EBM skills. Previous research experience had a bigger impact on these outcomes than any other predictor. EBM habits, self-efficacy, and skills did not appear to show even increases by year in residency. Previous EBM training was associated with more hours spent reading the literature and higher EBM skill test scores. Our findings suggest the practice of EBM may benefit from medical education increasing research experiences and EBM training. Research experiences provide the practical training, while EBM training provides focused instruction necessary for EBM self-efficacy, habits, and skills. These EBM outcomes are not inherently gained through time in family medicine residency. Future research, particularly longitudinal designs, should continue to pursue this line of inquiry.