Evidence-Based Medicine: Knowledge, attitudes and practices among senior medical students and interns in Oman
Rahma S. Al-Hadhrami, Al-Ghaliya N. Al-Shaqsi, Zahran M. Al Thuhli, Maryam Y. Al Sabbari
TL;DR
This study assesses how well senior medical students and interns in Oman understand and apply evidence-based medicine, finding significant gaps in their knowledge and practice.
Contribution
The study identifies deficiencies in EBM knowledge and practice among Omani medical trainees and suggests areas for improvement in EBM education.
Findings
Participants showed poor EBM knowledge (mean score 53.3%) and practices (35.3%) despite prior training.
No significant link was found between prior EBM training and current knowledge, attitude, or practice scores.
Knowledge scores were significantly associated with the level of study (P = 0.002).
Abstract
Evidence-based medicine (EBM) provides a systematic method for navigating an extensive repository of information and making well-informed judgements regarding patient care. This study aimed to evaluate the clinical knowledge, attitudes and practices related to EBM among medical students and interns in Oman and to identify gaps between general awareness and comprehension. This cross-sectional study was conducted from September 2023 to February 2024 at Sultan Qaboos University. An online survey incorporating the Noor Evidence-Based Medicine Questionnaire was used to evaluate knowledge, attitudes and practices related to EBM. Responses were scored using a 5-point Likert scale. A total of 230 medical students and interns completed the survey (response rate = 46%; the optimal sample size was determined to be 218 participants). The participants' mean age was 24.2 ± 1.5 years, with the…
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| Characteristic | n (%) |
|---|---|
|
| 24.2 ± 1.5 |
|
| |
| Male | 106 (46.1) |
| Female | 124 (53.9) |
|
| |
| Omani | 220 (95.7) |
| Non-Omani | 10 (4.3) |
|
| |
| JCR | 47 (20.4) |
| SCR | 77 (33.5) |
| Internship | 106 (46.1) |
|
| |
| SQU | 176 (76.5) |
| NU | 34 (14.8) |
| Abroad | 20 (8.7) |
|
| |
| Yes | 191 (83) |
| No | 39 (17) |
| Domain (% score) | n (%) |
|---|---|
|
| |
| Low (<60) | 5 (2.2) |
| Moderate (60–80) | 197 (85.7) |
| High (80) | 28 (12.2) |
|
| |
| Negative (<60) | 6 (2.6) |
| Neutral (60–80) | 164 (71.3) |
| Positive (>80) | 60 (26.1) |
|
| |
| Poor (<60) | 71 (30.9) |
| Fair (60–80) | 138 (60) |
| Good (>80) | 21 (9.1) |
| Level of knowledge, n (%) | ||||
|---|---|---|---|---|
|
| ||||
| Characteristic | Low | Moderate | High | |
|
| 23.0 ± 1.2 | 24.4 ± 1.5 | 23.5 ± 1.3 | 0.002 |
|
| ||||
| Male | 2 (1.9) | 95 (89.6) | 9 (8.5) | 0.260 |
| Female | 3 (2.4) | 102 (82.3) | 19 (15.3) | |
|
| ||||
| Omani | 5 (2.3) | 191 (86.8) | 24 (10.9) | 0.061 |
| Non-Omani | 0 (0) | 6 (60) | 4 (40) | |
|
| ||||
| JCR | 3 (6.4) | 33 (70.2) | 11 (23.4) | 0.002 |
| SCR | 1 (1.3) | 64 (83.1) | 12 (15.6) | |
| Internship | 1 (0.9) | 100 (94.3) | 5 (4.7) | |
|
| ||||
| SQU | 5 (2.8) | 144 (81.8) | 27 (15.3) | 0.005 |
| NU | 0 (0) | 34 (100) | 0 (0) | |
| Abroad | 0 (0) | 19 (95) | 1 (5) | |
|
| ||||
| Yes | 4 (2.1) | 160 (83.8) | 27 (14.1) | 0.066 |
| No | 1 (2.6) | 37 (94.9) | 1 (2.6) | |
| Level of practice, n (%) | ||||
|---|---|---|---|---|
|
| ||||
| Variable | Poor | Fair | Good | |
|
| 23.7 ± 1.3 | 24.4 ± 1.6 | 25.0 ± 1.1 | <0.001 |
|
| ||||
| Male | 22 (20.8) | 70 (66) | 14 (13.2) | 0.003 |
| Female | 49 (39.5) | 68 (54.8) | 7 (5.6) | |
|
| ||||
| Omani | 70 (31.8) | 129 (58.6) | 21 (9.5) | 0.074 |
| Non-Omani | 1 (10) | 9 (90) | 0 (0) | |
|
| ||||
| JCR | 20 (42.6) | 26 (55.3) | 1 (2.1) | 0.079 |
| SCR | 23 (29.9) | 48 (62.3) | 6 (7.8) | |
| Internship | 28 (26.4) | 64 (60.4) | 14 (13.2) | |
|
| ||||
| SQU | 56 (31.8) | 103 (58.5) | 17 (9.7) | 0.011 |
| NU | 13 (38.2) | 21 (61.8) | 0 (0) | |
| Abroad | 2 (10) | 14 (70) | 4 (20) | |
|
| ||||
| Yes | 59 (30.9) | 114 (59.7) | 18 (9.4) | 0.937 |
| No | 12 (30.8) | 24 (61.5) | 3 (7.7) | |
| n (%) | ||||
|---|---|---|---|---|
|
| ||||
| Aware of this | Uses this resource | |||
| Unaware of this | resource but | Reads/uses this | to help in clinical | |
| Resource | resource | does not use it | resource | decision-making |
| 184 (80) | 34 (14.8) | 10 (4.3) | 2 (0.9) | |
| Clinical Evidence database (BMJ Publishing Group, London, UK) | 112 (48.7) | 73 (31.7) | 26 (11.3) | 19 (8.3) |
| Cochrane Database of Systematic Reviews (Cochrane Collaboration, London, UK) | 52 (22.6) | 88 (38.3) | 72 (31.3) | 18 (7.8) |
| 120 (52.2) | 67 (29.1) | 31 (13.5) | 12 (5.2) | |
| PubMed/Medline databases (National Library of Medicine, Bethesda, Maryland, USA) | 8 (3.5) | 22 (9.6) | 79 (34.3) | 121 (52.6) |
| UpToDate clinical decision support system (Wolters Kluwer, Philadelphia, Pennsylvania, USA) | 5 (2.2) | 23 (10) | 64 (27.8) | 138 (60) |
| Medicine educational resources (McGraw Hill, New York, USA) | 119 (51.7) | 56 (24.3) | 34 (14.8) | 21 (9.1) |
| Google Scholar, an academic search engine (Google LLC, Mountain View, California, USA) | 24 (10.4) | 56 (24.3) | 83 (36.1) | 67 (29.1) |
| n (%) | ||||
|---|---|---|---|---|
|
| ||||
| It would not | Does not understand | Has some | Understands this | |
| be helpful to | this term but | understanding | term and could | |
| Term | understand this term | wants to | of this term | explain it to others |
| Relative risk | 8 (3.5) | 29 (12.6) | 103 (44.8) | 90 (39.1) |
| Absolute risk | 9 (3.9) | 34 (14.8) | 99 (43) | 88 (38.3) |
| Systematic review | 10 (4.3) | 25 (10.9) | 66 (28.7) | 129 (56.1) |
| Odds ratio | 9 (3.9) | 64 (27.8) | 99 (43) | 58 (25.2) |
| Meta-analysis | 7 (3) | 40 (17.4) | 75 (32.6) | 108 (47) |
| Clinical effectiveness | 9 (3.9) | 53 (23) | 102 (44.3) | 66 (28.7) |
| Confidence interval | 6 (2.6) | 64 (27.8) | 85 (37) | 75 (32.6) |
| Number needed to treat | 10 (4.3) | 46 (20) | 72 (31.3) | 102 (44.3) |
| Heterogeneity | 78 (33.9) | 71 (30.9) | 81 (35.2) | 0 (0) |
| Publication bias | 19 (8.3) | 43 (18.7) | 61 (26.5) | 107 (46.5) |
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Taxonomy
TopicsHealth and Well-being Studies
1. Introduction
Medical professionals are overburdened with data, making it challenging for them to identify the latest and most useful information for clinical practice, especially as physicians frequently need to make optimal choices for patient care.^1^ However, it is important to distinguish between the quantity and quality of information. Quantity is influenced by available resources and an individual's capacity to process data, while quality pertains to the information's complexity and relevance.^2^ Evidence-based medicine (EBM), officially defined by Gordon Guyatt in 1990, offers a structured approach for navigating the vast amount of available medical information by integrating patient values, clinical judgement and the best available research data.^34^ This strategy emphasises making treatment decisions grounded in solid evidence and scientific knowledge, thereby preventing the influence of individual habits and pharmaceutical marketing.^5^ EBM is crucial for setting national patient care standards by addressing gaps in clinical practices that depend on expert opinions rather than evidence. It offers a structured approach for evaluating and incorporating the best available evidence into clinical decision-making.^6^
Medical students are increasingly recognised as key drivers of the evidence-based shift in healthcare practices since they are the future healthcare providers. Thus, many medical schools now integrate EBM courses into their undergraduate curricula, preparing students to critically assess evidence and apply it in clinical settings, thereby fostering a culture of continuous learning.^7^ Moreover, various studies have demonstrated the effectiveness of curricula and educational interventions in enhancing medical students' understanding and application of EBM principles, particularly those that employ workshops and teamwork.^8910^ EBM workshops and mentored student projects have particularly been found to enhance students' abilities to formulate clinical questions and conduct appropriate literature searches, as well as to improve their attitudes towards learning.^1112^
Nonetheless, studies conducted across various regions worldwide have consistently revealed disparities in EBM knowledge, attitudes and practices among healthcare professionals, medical students and interns. For example, a study from Malaysia found that while 49.7% of emergency doctors exhibited a high level of EBM knowledge, only 39.9% maintained positive attitudes, and a mere 2.1% demonstrated good EBM practices.^13^ In Hungary, fewer than 10% of students were found to possess advanced EBM skills.^14^ Research from Saudi Arabia reported that 80.8% of medical students were unfamiliar with EBM concepts.^15^ A study from Syria documented limited EBM knowledge, neutral attitudes and poor practices among residents, with mean scores of 59.2%, 74.3% and 53.9%, respectively.^16^ Similarly, in Sudan, medical students exhibited deficiencies in EBM knowledge, research skills and attitudes.^17^ These findings collectively highlight not only the low levels of EBM knowledge across various regions but also the gap between theoretical knowledge and its practical application, underscoring the need for targeted interventions and further research to address these disparities.
In Oman, previous research has indicated that nurses demonstrate low levels of EBM knowledge and inadequate practices despite exhibiting positive attitudes towards this approach.^18^ However, there is a notable gap in research focusing on medical students and interns in Oman regarding their understanding of EBM concepts. Furthermore, it is essential to assess the disparity between self-reported EBM knowledge and actual comprehension. Therefore, this study aimed to investigate EBM-related clinical knowledge, attitudes and practices among Omani medical students and interns. By identifying areas for improvement, this study may contribute to ongoing efforts to enhance the integration of EBM principles into medical education and practice.
2. Methods
This cross-sectional study was conducted from September 2023 to February 2024 at Sultan Qaboos University (SQU), a prominent public university located in Muscat, Oman. The target population included medical students participating in their junior clerkship (JCR) and senior clerkship (SCR) rotations at SQU, as well as interns at the affiliated SQU Hospital (SQUH) who had recently graduated from medical school, regardless of their alma maters. The optimal sample size was determined to be 218 participants, calculated using an online sample size calculator (Raosoft Inc., Seattle, Washington, USA) with a 95% confidence level and a 5% margin of error based on an estimated population of 500 individuals (comprising 110 students in their JCR rotation, 110 in their SCR rotation and 280 interns).
A self-reported questionnaire was used to evaluate participants' EBM-related knowledge, attitudes and practices [Supplementary]. The first section of the questionnaire gathered sociodemographic information, while the remaining sections comprised the Noor Evidence-Based Medicine Questionnaire, which included 15, 17 and 11 items assessing EBM knowledge, attitudes and practices, respectively.^19^ Responses in each domain were scored using a 5-point Likert scale, with total scores transformed into percentage scores. Subsequently, percentage scores ranging from 60% to 79% in each domain were considered to indicate moderate knowledge, neutral attitudes and fair practices, respectively.^19^ Scores greater than 80% indicated high levels of knowledge, positive attitudes and good practices, while scores below this range reflected low knowledge, negative attitudes and poor practices. Previous research has confirmed the internal consistency of the Noor Evidence-Based Medicine Questionnaire across the knowledge, attitude and practice domains (Cronbach's alpha coefficient = 0.81, 0.81 and 0.84, respectively), indicating a high level of overall reliability.^19^ The final 2 sections of the Noor Evidence-Based Medicine Questionnaire included 8 and 10 items designed to assess participants' application and understanding of common EBM resources and terminology, respectively.
The final version of the survey was published online using Google Forms (Google LLC, Mountain View, California, USA). All JCR and SCR students at SQU, as well as interns working at SQUH, received emails containing a link to the online questionnaire. A reminder email was sent after 1 month due to a low initial response rate. Additionally, the primary investigators directly contacted potential participants at SQUH, on the SQU campus and in the college library to inquire about their willingness to participate in the study. Some interns at SQUH had graduated from universities other than SQU, including the National University of Science and Technology (NU), a private university also based in Muscat, Oman, as well as from universities abroad. The primary investigators tracked responses from the selected participant categories.
Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software, Version 29.0 (IBM Corp., Armonk, New York, USA). Continuous variables were reported as means with standard deviations, while categorical variables were presented as frequencies and percentages. An independent samples t-test was employed to compare means between groups, and a Chi-squared test (either Fisher's exact test or likelihood ratio) was conducted to assess associations between categorical variables. A multivariate binary logistic regression analysis was conducted to identify independent predictors of poor EBM practices. A P value of <0.05 was considered statistically significant.
3. Results
A total of 230 participants completed the questionnaire (response rate = 46%), comprising 47 (20.4%) junior medical students, 77 (33.5%) senior medical students and 106 (46.1%) interns. The mean age of the participants was 24.2 ± 1.5 years, with 124 (53.9%) identifying as female. Most respondents (n = 176, 76.5%) were affiliated with or had graduated from SQU, while 34 (14.8%) had graduated from NU, and 20 (8.7%) had graduated from universities abroad. Most participants (n = 191, 83.0%) reported having undertaken EBM-related training [Table 1]. The mean percentage scores for the knowledge, attitude and practice domains of the questionnaire were 53.33 ± 5.65%, 63.52 ± 7.57% and 35.32 ± 7.39%, respectively. As per the approach used by the developers of the original Noor Evidence-Based Medicine Questionnaire, these percentage scores indicate low levels of EBM-related knowledge, neutral attitudes towards EBM and poor EBM practices.^19^
Most of the participants (n = 197, 85.7%) demonstrated moderate levels of EBM-related knowledge. A smaller proportion exhibited low (n = 5, 2.2%) or high (n = 28, 12.2%) levels of knowledge [Table 2]. A significant association was found between the level of study and knowledge levels (P = 0.002); specifically, interns achieved moderate knowledge scores more frequently than senior or junior medical students (94.3% versus 83.1% and 70.2%, respectively). Significant correlations were also identified with university affiliation (P = 0.005) and age (P = 0.002). However, no significant differences were observed based on prior EBM training history, gender or nationality [Table 3].
Most participants (n = 164, 71.3%) exhibited neutral attitudes towards EBM, while 60 participants (26.1%) revealed positive attitudes, and only 6 participants (2.6%) reported negative attitudes [Table 2]. There were no significant differences in attitudes among junior medical students, senior medical students and interns (P = 0.251). Similarly, no significant differences were observed based on university affiliation or prior EBM training history (P = 0.209 and 0.419, respectively).
The evaluation of EBM practices among participants revealed that the majority were classified as having fair EBM practices (n = 138, 60%), followed by poor practices (n = 71, 30.9%), with only 21 respondents (9.1%) reporting good practices [Table 2]. Unlike the knowledge and attitude domains, significant differences in the practice domain were observed based on gender (P = 0.003). Female respondents reported poor practices more frequently than male respondents (39.5% versus 20.8%), while a higher proportion of males demonstrated good practices compared to females (13.2% versus 5.6%). Additionally, a significant association was observed concerning university affiliation (P = 0.011) [Table 4].
The most frequently utilised resources included UpToDate (60.0%), a clinical decision support system owned by Wolters Kluwer (Philadelphia, Pennsylvania, USA), and PubMed/Medline (52.6%), a comprehensive biomedical literature database maintained by the National Library of Medicine (Bethesda, Maryland, USA). Conversely, Bandolier (0.9%), a digital journal focused on evidence-based healthcare published by the University of Oxford (Oxford, UK), Best Practice (5.2%), an evidence-based journal and clinical decision support tool, and Clinical Evidence (8.3%), a database summarising the latest clinical research from the BMJ Publishing Group (London, UK), were the least utilised resources [Table 5].
Nearly half of the participants demonstrated familiarity with certain EBM terms, such as publication bias (46.5%), meta-analysis (47%) and the number needed to treat (44.3%). Furthermore, similar proportions of respondents exhibited some understanding of terms like relative risk (44.8%), clinical efficacy (44.3%), odds ratio (43%) and systematic review (43%). However, a smaller percentage of participants grasped concepts such as heterogeneity, with 33.9% indicating a perceived lack of relevance in understanding this term [Table 6].
4. Discussion
Much research has been done on investigated EBM in relation to medical practitioners. However, to the best of the authors' knowledge, the current study is the first comprehensive examination of EBM knowledge, attitudes and practices among Omani medical students and interns. This study's findings reveal generally low levels of EBM knowledge, neutral attitudes and poor practices. Effective clinical decision-making, based on recent, high-quality research, necessitates a critical appraisal to evaluate data validity and clinical relevance, thereby enabling medical professionals to make informed decisions regarding patient care. Developing basic skills to assess evidence validity and relevance is essential for all healthcare providers, as it improves clinical judgement even in the absence of extensive research expertise.^1456^
Teaching medical students about EBM positively impacts their education and future practice. Studies consistently show that EBM training enhances critical appraisal skills among medical students, fostering a greater understanding and confidence in EBM concepts, as well as improving their abilities to find and appraise medical literature.^81420^ However, despite these benefits, several challenges persist. Lafuente-Lafuente et al. highlighted that a significant proportion of medical professionals perceive their inability to critically appraise information as a barrier to practising EBM effectively.^21^ Similarly, other researchers have identified discrepancies between positive attitudes towards EBM and the actual knowledge and skills of medical students and young doctors.^2223^ Thus, while medical students generally recognise the importance of EBM in enhancing healthcare quality, patient outcomes and clinical decision-making, their understanding of EBM principles often remains limited.^924^
In the current study, 85.7% of respondents demonstrated a moderate level of knowledge of EBM, with fewer participants achieving high (12.2%) or low (2.2%) scores. These findings align with similar studies conducted in Malaysia and Kenya, which reported varying levels of EBM knowledge among healthcare professionals.^132526^ Interestingly, junior medical students in this study exhibited high levels of knowledge of EBM concepts more frequently than senior medical students and interns (23.4% versus 15.6% and 4.7%, respectively). This discrepancy suggests that the timing of EBM education within the medical curriculum may influence knowledge acquisition. Conversely, a Japanese study found no association between the year of residency and EBM knowledge, indicating stability in certain aspects of EBM knowledge over time.^27^ Disparities across studies may stem from differences in educational levels, phases of training and methodologies used for data collection. Despite these variations, it is evident that ongoing efforts are needed to improve EBM education and practice globally.
The decline in EBM knowledge observed as students advance through their academic years may indicate issues with knowledge retention or the effectiveness of current teaching approaches. However, since the current study did not examine the EBM curriculum's specific content, timing or structure, the precise reasons for this decline remain uncertain. Extending EBM instruction throughout the undergraduate years could help bridge knowledge gaps, particularly in applying EBM to clinical practice; however, exploring alternative teaching strategies should also be considered. For instance, targeted reinforcement during clinical years or increased opportunities for critical appraisal practice, such as additional journal clubs at the senior level, may be more effective in mitigating the natural decline in theoretical knowledge over time. Future studies should explore the details of EBM instruction and teaching practices in Oman, including the hours allocated, topics covered and teaching methods employed, to better understand potential gaps and identify effective strategies for optimising knowledge retention. It is also important to acknowledge that such strategies should aim to balance the competing demands of medical education while ensuring the long-term retention of essential knowledge.
Most participants in the current study (71.3%) exhibited neutral attitudes towards EBM, with 26.1% showing positive attitudes and only 2.6% expressing negative attitudes. Moreover, the mean percentage score was 63.5 ± 7.6%, indicating a predominantly neutral stance. These attitudes contrast notably with findings from a local study among primary care physicians, where 90% of respondents reported positive attitudes towards EBM.^28^ This disparity suggests variability in attitudes towards EBM between medical students and practising physicians, potentially indicating that attitudes towards EBM evolve throughout a healthcare professional's career. Research from Saudi Arabia revealed that 80.8% of medical students held negative attitudes towards EBM, while a survey conducted in Erbil City, Iraq, reported positive attitudes among 65.3% of medical students.^1529^ Positive attitudes were also observed among resident Japanese physicians and emergency doctors in Kelantan, Malaysia.^1327^
Interestingly, the current study found no significant difference in attitudes based on whether participants had received formal EBM training. This finding aligns with research conducted among Sudanese medical students, which similarly reported no notable difference in attitude scores between those with and without EBM training.^17^ Possible explanations for this may include the accessibility of self-implemented EBM courses online, which can provide a comparable level of exposure and understanding regardless of formal training. Additionally, variations in the delivery of formal training could contribute to this outcome; some courses may lack practical engagement or sufficient interaction with tutors, thereby limiting their effectiveness in shaping attitudes towards EBM. Longitudinal studies that track changes in attitudes throughout various stages of medical training and into practice settings could provide deeper insights into how attitudes towards EBM develop over time and the factors influencing these changes. Understanding these dynamics is crucial for designing effective EBM curricula that not only impart knowledge but also foster positive attitudes and behaviours towards evidence-based practice among future healthcare professionals.
While research evidence provides a crucial foundation, practical wisdom and experience are indispensable in clinical decision-making.^30^ Integrating both evidence-based knowledge and clinical expertise is essential for delivering optimal patient care and should be a cornerstone of medical education. However, medical students and interns often struggle to translate their knowledge and positive attitudes towards EBM into practice during clinical encounters. This study found that 60% of respondents demonstrated fair practice levels, while 30.9% exhibited poor levels, and only 9.1% achieved good practice. The mean percentage score was 35.3 ± 7.4%, indicating overall poor practices. This finding aligns with previous studies that also revealed poor EBM practices among medical students and resident physicians in Sudan and Kenya.^1726^
Alahdab et al. found that while medical students expressed confidence in their EBM skills, they still struggled to apply these skills in real-world scenarios due to time constraints and the complexities of clinical decision-making processes.^16^ Similarly, other studies have reported challenges in integrating EBM principles into daily practice among young doctors, who cited barriers such as a lack of resources, patient preferences and clinical inexperience.^3132^ These practical challenges may stem from insufficient knowledge and neutral attitudes towards EBM, underscoring the need for ongoing, comprehensive training and support to help medical students and interns overcome these barriers and effectively implement EBM principles in clinical practice.
Medical students often lack awareness of EBM resources and terminology, which hinders their ability to effectively practice EBM.^9^ The current study found that the most popular EBM resource was UpToDate, followed by the PubMed/Medline database. In contrast, a study conducted in Malaysia reported that the most frequently accessed database among local primary care practitioners was PubMed (65.3%), with only one-third of respondents using UpToDate.^25^ Similarly, research involving resident physicians in Japan indicated that PubMed was the most utilised EBM resource.^27^ Interestingly, some participants in this study acknowledged that they did not fully understand certain EBM concepts but still expressed a desire to learn more. This suggests a knowledge gap that could be addressed through targeted training and educational programmes. Other research has similarly revealed a poor understanding of specific EBM terms like systematic review and odds ratio among medical students, underscoring the need for specialised instruction in this field.^33^
Despite its strengths, this study has certain limitations. The cross-sectional design inherently limits the ability to establish causality, as it can only determine associations. Additionally, recall bias is a potential issue, as participants may struggle to remember past events or experiences accurately. Selection bias may also be a concern, given that the sample may not fully represent the entire population. Furthermore, the use of online self-reported questionnaires can introduce response bias, with participants potentially providing socially desirable answers, which may lead to delays or a low response rate. Moreover, despite prior validation of the questionnaire, its design may still have introduced bias if the questions were unclear or misleading. Lastly, the study did not include an analysis of the EBM curriculum currently taught to students, such as its duration, content and teaching methods. Therefore, the conclusions and recommendations should be interpreted cautiously and considered as preliminary observations rather than definitive solutions. A more comprehensive understanding of the teaching environment is necessary to validate and refine these recommendations. Future research should investigate the structure and scope of EBM education to ensure that interventions are well-targeted and evidence-based.
5. Conclusion
While medical students and interns in Oman demonstrated a basic grasp of EBM principles, their attitudes were predominantly neutral, and they faced challenges in applying these principles in clinical situations. These findings highlight the necessity for comprehensive and targeted EBM education throughout medical training and the early years of professional practice to enhance understanding and cultivate positive attitudes crucial for effective integration into clinical practice. Further investigation is needed to identify effective strategies for integrating EBM into curricula, assess the actual implementation of EBM in clinical practice and address the challenges faced by medical students and interns when applying EBM in real-life scenarios.
Authors' Contribution
Rahma S. Al-Hadhrami: Conceptualization, Methodology, Formal analysis, Writing - Original Draft, Writing - Review & Editing. Al-Ghaliya N. Al-Shaqsi: Conceptualization, Methodology, Formal analysis, Writing - Original Draft, Writing - Review & Editing. Zahran M. Al Thuhli: Investigation, Formal analysis, Writing - Review & Editing. Maryam Y. Al Sabbari: Investigation, Formal analysis, Writing - Review & Editing.
Ethics Statement
Ethical approval for the study was obtained from the Medical Research and Ethics Committee of the College of Medicine and Health Sciences at SQU (SQU-EC/121/2023; MREC #3013). All participants provided written informed consent prior to completing the survey.
Conflict of Interest
The authors declare that there are no conflicts of interest.
Funding
No funding was received for this study.
Data Availability
Data are available upon reasonable request from the corresponding author.
Acknowledgements
The authors would like to thank all of the participants who volunteered in this study, as well as Sultan Qaboos University staff who gave their valuable time to this endeavour.
Supplementary Material
The reference list from the paper itself. Each links out to its DOI / PubMed record.
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