Cochrane, Evidence-based Medicine and Associated Factors: A Cross-sectional Study of the Experiences and Knowledge of Ethiopian Specialists in Training

Introduction: Evidence-based healthcare is a core competency for practicing healthcare practitioners and those in speciality training. In sub-Saharan Africa, little is known about the teaching of evidence-based medicine (EBM) in residency program. This survey evaluated the experiences and knowledge of Cochrane, EBM and associated factors among Ethiopian specialists in training.

Methods: A convenient sample of trainee specialists completed a pretested self-administered survey. The majority (93%) were ≤30 years old, males (63%) and 41% in paediatrics speciality. The associations of categorical variables with EBM knowledge was assessed by Fisher's exact or Chi-Square tests. Covariates contributing to EBM knowledge were identified using multivariate logistic regression analysis.

Results: Eighty-three trainees participated in the survey (response rate 88.2%). About 75% have heard about Cochrane but no one recognized Cochrane South Africa. Only 25% of the trainees knew the Cochrane Library but none used it in clinical practice. Most (78%) have heard of EBM, 15% had attended EBM course, 96% wanted to attend EBM course and 81% had positive attitudes to EBM. Trainees EBM knowledge was associated with awareness of Cochrane [Adjusted odds ratio (AOR) = 8.5, 95% Confidence interval (CI) 1.3-54.6, P = 0.02], EBM (AOR = 51.2, 95% CI 2.7-960.8, P = 0.009), and being in third year training (AOR = 28.4, 95% CI 1.9-427.2, P = 0.02). The promotion of EBM in residency hospital (AOR = 22.2, 95% CI 2.2-223.8, P = 0.008) and being aware of Cochrane (AOR = 4.8, 95% CI 1.1-21.7, P = 0.04) were predictors of positive attitude. Familiarity with Cochrane Library was influenced by EBM knowledge (AOR = 6.6, 95% CI 1.4-31.5, P = 0.02) and perceived organization barrier to accessing the resource (AOR = 3.2, 95% CI 1.03-10.1, P = 0.04).

Conclusion: Ethiopian trainee specialists lacked formal EBM training, awareness and use of the Cochrane Library. To improve the healthcare quality and patient outcomes, EBM education should be integrated into residency curricula.