Experiences of general practitioners and practice nurses of training courses in evidence-based health care: a qualitative study

Background. Clinical governance will require general practitioners (GPs) an d practice nurses (PNs) to become competent in finding, appraising, and imp lementing research evidence - the skills of evidence-based health care (EBH C). Aim. To report the experiences of GPs and PNs in training in this area. Method. We held 30 in-depth, semi-structured interviews throughout North Th ames region with three groups of informants: primary care practitioners rec ruited from the mailing lists of established EBHC courses; organizers and t eachers on these courses; and educational advisers from Royal Colleges, uni versities, and postgraduate departments. Detailed qualitative analysis was undertaken to identify themes from each of these interview groups. Results. At the time of the fieldwork for this study (late 1997), remarkabl y few GPs or PNs had attended any formal EBHC courses in our region. Percei ved barriers to attendance on courses included inconsistency in marketing t erminology, cultural issues (e.g. EBHC being perceived as one aspect of rap id and unwanted change in the work-place), lack of confidence in the subjec t matter (especially mathematics and statistics), lack of time, and practic al and financial constraints. Our interviews suggested, however, that the p rinciples and philosophy of EBHC are beginning to permeate traditional lect ure-based continuing medical education courses, and consultant colleagues i ncreasingly seek to make their advice 'evidence based: Conclusion. We offer some preliminary recommendations for the organizers of EBHC courses for primary care. These include offering a range of flexible training, being explicit about course content, recognizing differences in p rofessional culture between primary and secondary care and between doctors and nurses, and addressing issues of funding and accreditation at national level. Introducing EBHC through traditional topic-based postgraduate teachi ng programmes may be more acceptable and more effective than providing dedi cated courses in its theoretical principles.