بررسی موانع کاربست و نهادینه سازی پزشکی مبتنی بر شواهد در بخش های بالینی از دیدگاه دستیاران و متخصصین بالینی

Background and Objective: In recent years, many efforts are made in education and development of evidence-based medicine at medical sciences universities. Many different methods are used in training and empowering clinical assistants, medical students and general practitioners in Iran and other countries, but despite their positive effects on increasing knowledge, skills, and attitudes of learners there are not notable and sustainable effects on evidence‑based medicine establishment. The present study aimed to investigate the barriers to implementation and institutionalization of evidence-based medicine in clinical wards. Materials and Methods: This study was a qualitative approach using content analysis of clinical assistants and medical education experts’ viewpoints who participated in EBM courses. The current status of EBM implementation was determined using a questionnaire and then experts were asked to mention the barriers of applying the EBM in real environments. The viewpoints of a group of experts consisted of 10 clinical faculty members and clinical assistants who participated in focus group study were classified by quantitative and qualitative content analysis. Results: After analyzing the residents and faculty members' viewpoints, barriers to implementation of evidence-based medicine in clinical settings from their perspective were classified into 31 items and 7 components included facilities, quality of training, tracking and accountability, clinical environment, and factors related to faculty members and clinical assistants. A summary of 10 faculty members' viewpoints was classified into19 items and 5 factors. Conclusion: The development and institutionalization of evidence-based medicine is affected by environmental and individuals attitudes in clinical wards. However, developing this approach requires ameliorating hardware facilities, rules, management support, education and empowerment, responsibility and accountability which also affect one another.