They point out that the journals have a scholarly rather than practical approach to solving clinical matters at hand, (Department of Medical Sociology, 1998).
With the aim of exploring the barriers that GPs face in the implementation of EBM in routine clinical work and identifying possible strategies in its integration in daily work; studies have been carried out to explore this phenomenon in various parts of the world.
One such study was carried out by Kenneth S Yew (MD) and Alfred Reid (MA) from the Uniformed Services University and The University of North Carolina respectively, (Physicians for the twenty-first century, 1984). They held focus group discussions with 10 General Practitioners (GPs) in public and private practice in the randomly selected from Charlotte and its environs. The aim was to find out the long term effects of teaching Critical Appraisal and Evidence Based Medicine on practicing physicians. Their goal was to explore ways in which the long-term outcomes of an integrated CA/EMB curriculum could be evaluated using a qualitative analysis of self-reported use of the two skills in everyday medical practice. Their secondary goal was to find out barriers to CA/EMB application. Reinhold Wentz has estimated that 50,000 physicians, students and health care workers receive training each year, Wentz R. (2001).
Participants mentioned that they had found the approach they used in residency was still helpful to them in situations that they faced as full time GPs, but only in circumstances that allowed them to search and reflect.
However, where they immediately had patients to deal with, they preferred to rely on their own intuition and experience. A good number of them expressed guilt that they were not applying the EBM methods even though they were fully aware of how useful these were. Consequently, when it came to the question of barriers, almost all those interviewed were unanimous that time was the main culprit. Some pointed out that where they had to choose between attending to patients and making references, they often found themselves opting for the former. About 30% of the respondents said that they applied the EBM methods regularly but not when resolving an immediate clinical question.
Conversely, all the participants were also unanimous on the importance of attending CME courses and as a matter of fact they did attend them. They were sure that they valued keeping up to date as it gave them immense satisfaction. 2% of the participants identified CME as their primary self-learning method. All reported that they regularly read journals while 5% read their specialty society journal regularly. About half also identified teaching and questions arising from patients as their main incentive for learning. Apart from luck of time, the participants also mentioned that the nature of their work kept them constantly under pressure to produce clinically. The majority expressed frustration at this constant pressure to perform, a common sentiment among GPs. Barnett SH et al (2000). Unfortunately, none of them associated performing in their duties with applying EBM since they mostly regarded this as a drawback on quick efficiency. Yet they all felt that they could do their work much better if they found the space in their punishing schedules to make references a little more and keep up to date. They figured