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BMC Medicine

, 9:30

First Online: 30 March 2011Received: 11 February 2011Accepted: 30 March 2011DOI: 10.1186-1741-7015-9-30

Cite this article as: Lai, N.M., Teng, C.L. & Lee, M.L. BMC Med 2011 9: 30. doi:10.1186-1741-7015-9-30


BackgroundIndependent evaluation of clinical evidence is advocated in evidence-based medicine EBM. However, authors- conclusions are often appealing for readers who look for quick messages. We assessed how well a group of Malaysian hospital practitioners and medical students derived their own conclusions from systematic reviews SRs and to what extent these were influenced by their prior beliefs and the direction of the study results.

MethodsWe conducted two cross-sectional studies: one with hospital practitioners n = 150 attending an EBM course in June 2008 in a tertiary hospital and one with final-year medical students n = 35 in November 2008. We showed our participants four Cochrane SR abstracts without the authors- conclusions. For each article, the participants chose a conclusion from among six options comprising different combinations of the direction of effect and the strength of the evidence. We predetermined the single option that best reflected the actual authors- conclusions and labelled this as our best conclusion. We compared the participants- choices with our predetermined best conclusions. Two chosen reviews demonstrated that the intervention was beneficial -positive-, and two others did not -negative-. We also asked the participants their prior beliefs about the intervention.

ResultsOverall, 60.3% correctly identified the direction of effect, and 30.1% chose the best conclusions, having identified both the direction of effect and the strength of evidence. More students 48.2% than practitioners 22.2% chose the best conclusions P < 0.001. Fewer than one-half 47% correctly identified the direction of effect against their prior beliefs. -Positive- SRs were more likely than -negative- SRs to change the participants- beliefs about the effect of the intervention relative risk RR 1.8, 95% confidence interval 1.3 to 2.6 and -convert- those who were previously unsure by making them choose the appropriate direction of effect RR 1.9, 95% confidence interval 1.3 to 2.8.

ConclusionsThe majority of our participants could not generate appropriate conclusions from SRs independently. Judicious direction from the authors- conclusions still appears crucial to guiding our health care practitioners in identifying appropriate messages from research. Authors, editors and reviewers should ensure that the conclusions of a paper accurately reflect the results. Similar studies should be conducted in other settings where awareness and application of EBM are different.

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Electronic supplementary materialThe online version of this article doi:10.1186-1741-7015-9-30 contains supplementary material, which is available to authorized users.

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Autor: Nai Ming Lai - Cheong Lieng Teng - Ming Lee Lee


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