Medical Science Educator

, Volume 21, Issue 4, pp 347–354 | Cite as

Barriers to Incorporating NICE Clinical Practice Guidelines in Medical Education: The Medical Student’s Perspective

  • Logan ManikamEmail author
  • Jaydip Banerjee
  • Nicholas Blackwell
  • Monica Lakhanpaul
Original Research



Clinical practice guidelines (CPG) developed by the National Institute for Health and Clinical Excellence (NICE) aim to address National Health Service (NHS) practice inequalities by supporting clinicians deliver best patient care to address practice inequalities. As the future NHS workforce, it is important to quantify medical students’ knowledge of and attitude towards evidence based medicine (EBM) and NICE CPGs to identify barriers influencing evidence based medicine and CPG implementation.


We administered an online survey to medical students in England and Wales to study attitudes and knowledge of EBM and CPGs. We performed Mann-Whitney and Kruskal-Wallis tests to compare different groups’ continuous variable means.


We received 323 responses across seven medical schools. A scale reliability alpha of 0.71 reflected satisfactory questionnaire internal consistency. Students were unsure regarding development processes such as 3 year implementation timeframes (74%) and role of academic medical colleges, drug companies and lay public. Students understood the scientific evidence application in decision-making processes (83%) and that clinicians should practice EBM (87%). 77% and 51% of students believe CPG’s influence drug availability and decrease practice autonomy respectively. Two thirds of students felt guidelines reduced patient choice.


The majority of medical students understood the importance and role of evidence based medicine and NICE guidelines. However, poor knowledge on processes of guideline development and negative views on aspects of NICE CPGs may be construed as barriers that may affect implementation in future evidence-based practice. Research is warranted to develop an educational framework for future educational strategy implementation.


Survey Medical Student NICE guidelines Evidence based practice 


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  1. 1.
    Tooke (2007) et al: Report of High Level Group on Evidence based clinical effectivenessGoogle Scholar
  2. 2.
    General Medical Council. Tomorrow’s Doctors September 2009 Available at: Updated 2010
  3. 3.
    Field MJ, Lohr MJ, (eds.): Clinical Practice Guidelines: Directions for a New Program Washington, DC: National Academy Press; 1990Google Scholar
  4. 4.
    Grimshaw, J. M., Eccles, M. P., Walker, A. E. & Thomas, R. E. (2002) Changing physicians’ behavior: what works and thoughts on getting more things to work. Journal of Continuing Education in the Health Professions, 22, 237–243.CrossRefGoogle Scholar
  5. 5.
    Implementation barriers for general practice guidelines on low back pain a qualitative study. Spine, 26, E348–E353.Google Scholar
  6. 6.
    Farquhar, CM., Kofa, E.W. and Slutsky, J.R. (2002) Clinicians’ attitude to clinical practice guidelines: a systematic review. Medical Journal of Australia, 2002; 177, 502–506Google Scholar
  7. 7.
    Sheldon, T. A., Cullum, N., Dawson, D., Lankshear, A., Lowson, K., Watt, I., West, P., Wright, D. & Wright, J. (2004) What’s the evidence that NICE guidance has been implemented? Results from a national evaluation using time series analysis, audit of patient’s notes, and interviews. British Medical Journal, 329, 999.CrossRefGoogle Scholar
  8. 8.
    Davis, E., & Littlejohns, P. (2002). Views of directors of public health about NICE appraisal guidance: Results of a postal survey. J Public Health Med, 24(4), 319–325.CrossRefGoogle Scholar
  9. 9.
    Buxton, M. (2006) Economic Evaluation and Decision Making in the UK. Pharmacoeconomics, 24, 1133–42.CrossRefGoogle Scholar
  10. 10.
    Miller, G. E. (1990) The assessment of clinical skills/competence/performance. Academic Medicine, 65, S63–S67.CrossRefGoogle Scholar
  11. 11.
    Dahan R et al (2006) Is knowledge a barrier to implementing low back pain guidelines? Assessing the knowledge of Israeli family doctors. Journal of Evaluation in Clinical Practice Google Scholar
  12. 12.
    Epstein R.M; Assessment in Medical Education N Engl J Med 2007 356: 4 387–396CrossRefGoogle Scholar
  13. 13.
    E Meats, C Heneghan, M Crilly, P Glasziou Evidence-based medicine teaching in UK medical schools Medical Teacher 2009 31,4 p 332–337CrossRefGoogle Scholar
  14. 14.
    National Institute for Health and Clinical Excellence — About clinical guidelines Last updated: 2010 Assessed at:
  15. 15.
    Haycox A Clinical guidelines — the hidden costs BMJ 1999; 318: 391CrossRefGoogle Scholar
  16. 16.
    National Institute for Health and Clinical Excellence — NICE education modules Last updated: 2010 Assessed at:
  17. 17.
    Ilic, D. et al. Undergraduate medical student perceptions and use of Evidence Based Medicine: A qualitative study BMC Medical Education 2010,10;58CrossRefGoogle Scholar
  18. 18.
    Ash S. et al. Legal considerations of clinical guidelines: will NICE make a difference? J R Soc Med 2003 March; 96(3): 133–138CrossRefGoogle Scholar
  19. 19.
    Dorsch, J.L. Impact of an evidence-based medicine curriculum on medical students’ attitudes and skills J Med Libr Assoc 2004 October; 9294): 397–406Google Scholar
  20. 20.
    Donnely L (2010) The Telegraph — Axe falls on NHS services Assessed at:
  21. 21.
    Owen-Smith, A. The desirability of being open about health care rationing decisions: findings from a qualitative study of patients and clinical professionals J Health Serv Res Policy 2010; 14: 14–20CrossRefGoogle Scholar
  22. 22.
    Anderson, W. Consulting the public about the NHS BMJ 2000; 320: 1553Google Scholar
  23. 23.
    National Institute for Health and Clinical Excellence. (2004). An education strategy to support implementation of NICE guidanceGoogle Scholar
  24. 24.
    Sandars, J.; Siddiqi, K.; Walsh, K. et al. An undergraduate education package on evidence-based medicine: some NICE lessons Medical Education 2010 44;5;511–512CrossRefGoogle Scholar

Copyright information

© Springer International Publishing 2011

Authors and Affiliations

  • Logan Manikam
    • 1
    Email author
  • Jaydip Banerjee
    • 2
  • Nicholas Blackwell
    • 1
  • Monica Lakhanpaul
    • 1
    • 3
  1. 1.University of LeicesterLeicesterUK
  2. 2.University Hospitals of Leicester NHS TrustLeicesterUK
  3. 3.Leicester City Community Health ServicesLeicesterUK

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