The Journal of Bone and Joint Surgery (American). 2007;89:206-215.
doi:10.2106/JBJS.F.00633
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Perceptions and Competence in Evidence-Based Medicine: Are Surgeons Getting Better?

A Questionnaire Survey of Members of the Dutch Orthopaedic Association

Rudolf W. Poolman, MD1, Inger N. Sierevelt, MSc2, Forough Farrokhyar, MPhil, PhD1, J. Adriaan Mazel, MD, PhD3, Leendert Blankevoort, PhD2 and Mohit Bhandari, MD, MSc, FRCSC1

1 Division of Orthopaedic Surgery, McMaster University, Hamilton General Hospital, 7 North, Room 727, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada. E-mail address for R.W. Poolman: poolman{at}trauma.nl
2 Orthotrauma Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, G4 Noord, PO Box 22660, 1100 DD Amsterdam, The Netherlands
3 Prins Bernhardlaan 43, 7622 BE, Borne, The Netherlands

Disclosure: In support of their research for or preparation of this work, one or more of the authors received grants or outside funding. Dr. Bhandari is supported, in part, by a Canada Research Chair from the Canadian Institutes of Health Research. Dr. Poolman is supported, in part, by a Stichting Wetenschappelijk Onderzoek Orthopaedische Chirurgie Fellowship, Biomet Netherlands, Anna Fonds, Zimmer Netherlands, MSD The Netherlands, and a Nederlandse Vereniging voor Orthopedische Traumatologie Fellowship. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

NOTE: The authors acknowledge Kristen Postma for her help in translating the questionnaire and Shelley Kraus and Ryan Speller for their correction of the English language as native speakers.

Background: The Journal of Bone and Joint Surgery, American Volume (The Journal) recently initiated a section called "Evidence-Based Orthopaedics." Furthermore, a level-of-evidence rating is now used in The Journal to help readers in clinical decision-making. Little is known about whether this recent emphasis has influenced surgeons' perceptions about and competence in evidence-based medicine. Therefore, we examined perceptions and competence in evidence-based medicine among Dutch orthopaedic surgeons.

Methods: Members of the Dutch Orthopaedic Association were surveyed to examine their attitudes toward evidence-based medicine and their competence in evidence-based medicine. We evaluated competences using a newly developed instrument tailored to surgical practice.

Results: Of the 611 members, 367 surgeons (60%) responded. Orthopaedic surgeons welcomed evidence-based medicine. Practical evidence-based medicine resources were perceived as the best method to move from opinion-based or experience-based to evidence-based practice. Four variables were significantly and positively associated with the competence instrument: (1) a younger age, particularly between thirty-six and forty-five years (p = 0.007), (2) experience of less than ten years (p = 0.032), (3) having a PhD degree (p < 0.001), and (4) working in an academic or teaching setting (p = 0.004). The majority of the respondents were aware of The Journal's evidence-based medicine section (84%) and level-of-evidence ratings (65%), and 20% used The Journal's evidence-based medicine abstracts in clinical decision-making. This increased awareness of evidence-based medicine was also reflected in the frequent use of Cochrane reviews in clinical decision-making (27% of the respondents). Surgeons who used and those who were aware of but did not use The Journal's evidence-based medicine abstracts or Cochrane reviews in clinical decision-making had significantly higher competence instrument scores than those who were unaware of these resources (p = 0.03 and p < 0.001, respectively).

Conclusions: Evidence-based medicine is welcomed by Dutch orthopaedic surgeons. The recent emphasis on evidence-based medicine is reflected in an increased awareness about The Journal's evidence-based medicine section, levels of evidence, and the largest evidence-based medicine resource: the Cochrane reviews. Younger orthopaedic surgeons had better knowledge about evidence-based medicine. The development and use of evidence-based resources as well as preappraised summaries such as The Journal's evidence-based medicine abstracts and Cochrane reviews were perceived as the best way to move from opinion-based to evidence-based orthopaedic practice.


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