Impact of Evidence-Based Dentistry Workshops on Educators’ Use of Evidence in Teaching and Practice: A Pilot Study

Discussion

Prior studies have identified strategies to implement EBP, including the use of systematic reviews and evidence-based guidelines, audiovisual resources, and electronic publications.^16,17 However, studies have also favored active knowledge translation strategies, such as educational meetings and workshop trainings^18,29 over passive ones.³⁰ Therefore, it seems highly desirable to support efforts to encourage the conception, evaluation, and enhancement of dynamic and interactive knowledge translation interventions, such as the workshop we assessed in our study.

Faculty members’ positive overall attitudes towards EBD have been frequently reported.^29,31–34 Our workshop participants expressed similar attitudes in Survey I, in which both the lectures and the hands-on exercises were found to be useful. However, other studies have found overall preference for practical activities.^33,35 The participative and interactive format used in our workshops was perceived as beneficial for attendees to learn the EBD concepts. This finding supports the idea that learning environments should promote self-monitoring skills, allowing attendees to regulate their learning and actively engage themselves in learning tasks.³⁵

According to the Survey II results, one of the most important self-reported benefits from the EBD workshops was improvement of attendees’ critical appraisal skills when assessing evidence. This ability is key to establishing an evidence-based approach and supports the development of students’ critical thinking skills.³⁶ Our findings support previous studies in which similar educational strategies were used with educators from various health sciences disciplines.^29,37 Critical appraisal is a core skill for EBP, so that professionals can make sense of evidence and judge its trustworthiness, value, and relevance in particular contexts.³⁸ This skill becomes even more critical when dealing with the continuously increasing magnitude of published evidence, particularly when concerns are raised regarding the quality of that evidence³⁹ or when evidence-based clinical guidelines synthesizing scientific evidence and helping professionals in their clinical decision making are still missing.⁴⁰

On the other hand, a small part of the sample in our study did not take full benefit of the workshops, suggesting a need for improvement in the workshop format. However, we do not know if the variations in perceptions of the workshops’ value might have resulted from disparities in participants’ pre-workshop levels of EBD knowledge and skills since no pretest was performed. As suggested by Forrest and Miller, a more thorough assessment of the initial situation or problem can provide valuable information to help refine the goals and activities of future EBD training sessions.⁴¹

All workshop attendees in our study reported that they were currently implementing EBD or planning to do so in the near future, either during their clinical or teaching practice. They perceived that the workshops improved their knowledge and skills in EBD and facilitated application of these concepts during their routine decision making processes. Other practical effects of EBP workshops have been documented by other researchers, including the improved ability to determine clinical applicability of evidence, review one’s own practice, collaborate with other professionals, and teach EBD concepts in home institutions.^29,37,41 The sharing of EBD knowledge was also reported by most of our respondents, as they stated they routinely guide their colleagues through an EBD approach, corroborating the idea that trained faculty members can mentor their peers.³⁶

With respect to students’ and/or patients’ reactions to EBD practice among our respondents, there were only a few reports of resistance from students, mainly related to the difficulty in applying EBD concepts. Hence, attendees reported that the majority of students and patients reacted positively, including that it increased their trust in the treatment options provided. This result is consistent with another study’s finding that patients were seen as EBD facilitators.¹⁴ Therefore, making EBD courses more frequent, teaching students how to critically appraise evidence, and making the use of evidence-based treatments mandatory in the entire dental program should make EBD increasingly familiar, reducing the difficulty of embracing it later on. Moreover, teaching dental students how to be lifelong learners is key to maintaining the application of current best evidence in daily practice, thus optimizing patient outcomes.³⁶

According to our respondents, their colleagues and students reacted well to the use of EBD in decision making, with only 30% reporting concerns or objections from their peers or students. The main barrier to implementation of EBP in these cases related to difficulties in changing one’s behavior due to overreliance on personal experiences.^1,2,14 Integrating EBD in the early years of dental education may potentially reduce this issue, as students, with proper guidance, may begin to adopt EBP as a customary behavior.

Some of the barriers reported in a previous study were seen as less problematic obstacles in our study.¹⁵ These previously reported barriers included difficulties in interpreting research results due to academic language, lack of familiarity with searching for relevant information, and the high cost of academic journals. The absence of those barriers in our study could be predictable, as our sample was comprised of academics who share an interest in research and often undergo specific training. Furthermore, individuals affiliated with an educational institution have nearly unlimited access to publications and resources at no personal cost. General practitioners, on the other hand, have reported lack of appropriate training, inaccessibility of evidence, financial restrictions, and lack of time due to heavy workload as significant barriers.^6–8,10

Corroborating the findings of Spallek et al.,¹⁴ we found the most demanding barriers to be lack of up-to-date evidence for many devices and products used in the profession and continuing dental education courses that were not up-to-date with respect to evidence. Whereas the former obstacle can be partially explained by current continual launching of new products into the dental market before related evidence becomes available to the users, the latter is indeed a disturbing barrier due to the fact that continuing education is usually intended to improve patients’ quality of care. Therefore, it would be expected to be grounded in sound scientific basis, but it seems to be otherwise, essentially based on case reports of new techniques or products that have yet to be subjected to rigorous scientific investigation.

Advantages of our study included that the time span in which participants completed the online Survey II (ten to 31 months after the workshops) allowed attendees to reflect on the concepts learned and reinforced during training sessions and to experiment and consolidate them into practice. This study also obtained relatively high response rates, particularly when compared to standard response rates to web-based surveys.⁴² This higher rate may have been due to the common interest in EBP shared by our sample. It is possible that the response rate could have been further improved if a mail option was also provided.⁴³

The main limitation of our study was related to the fact that, as a pilot study, it was comprised of an initial small sample size and therefore no inferential statistical analysis could be justified. Therefore, the results from this study, while useful in informing the design and implementation of future larger scale studies of EBD training, must be interpreted with appropriate caution until replication research can verify our findings. Due to the very nature of a pilot study and its small sample size, our results should not be considered a preliminary test of hypotheses related to the efficacy of this format of workshops on attendees’ EBD implementation.⁴⁴ In addition, the fact that we did not distinguish the faculty members’ responses from those of the postdoctoral students means we were unable to separately assess the workshops’ impact on the faculty members, who will have a continuing impact on dental students and dental education into the future.

Moreover, as this study was performed within a primarily academic population, our findings represent the views of a restricted group of individuals exposed to a very specific EBD workshop format. Hence, the representativeness of their views may not reflect the ones shared by the dental community as a whole or even of most dental academics. Nevertheless, the responses and comments can be considered a useful initial step for related research in the future. In that sense, it seems highly desirable to conduct future investigations describing academic and non-academic dentists, as well as to compare the behaviors of both groups of professionals after EBD educational interventions.

Thomas et al. found that teaching interventions tended to produce a greater impact on knowledge and skills than they did on sustainable EBP behaviors.³⁵ Even though we did observe an overall positive short-term effect, future studies should thus focus on behavioral long-term effects of EBP teaching interventions. Additionally, as well as an introduction of EBD concepts through hands-on exercises, expanded workshops with more regular online feedback opportunities could be developed.²⁹ Ongoing follow-ups, rather than a single evaluation, could provide a better understanding of how attendees’ implementation of EBD into practice unfolds over time.⁴¹ Furthermore, it would be helpful to further explore specific, individualized, and effective EBD teaching methods³⁷ and to develop and implement distance-learning strategies, focused on supporting attendees during their everyday clinical or teaching practice.