Journal of General Internal Medicine

, Volume 22, Issue 3, pp 327–331 | Cite as

The Impact of an Evidence-Based Medicine Educational Intervention on Primary Care Physicians: A Qualitative Study

  • Kerem Shuval
  • Aviv Shachak
  • Shai Linn
  • Mayer Brezis
  • Paula Feder-Bubis
  • Shmuel Reis
Original Article


Attitudes and barriers to implementing EBM have been examined extensively, but scant evidence exists regarding the impact of EBM teaching on primary care physicians’ point of care behavior.


Gaining insight into behavioral and attitudinal changes of facilitators and participants during a multifaceted EBM educational intervention.

Design, setting, and participants

A qualitative study on primary care physicians and facilitators from a large HMO selected from the intervention arm of a parallel controlled trial using purposeful sampling. We conducted focus groups with 13 facilitators and 17 physicians and semi-structured interviews with 10 facilitators and 11 physicians.


Both facilitators and participants believed EBM enhanced the quality of their practice. The intervention affected attitudes and knowledge, but had little impact on physicians’ ability to utilize pre-appraised resources at the point of care. Using EBM resources during consultation was perceived to be a complex task and impractical in a busy setting. Conversely, a positive impact on using medication databases was noted. Medication databases were perceived as easy to use during consultations in which the benefits outweighed the barriers. The intervention prompted physicians to write down clinical questions more frequently and to search for answers at home.


This study underlines the need not only to enhance EBM skills, but also to improve the ease of use of EBM resources at the point of care. Tasks should be simplified by tailoring evidence-based information retrieval systems to the busy clinical schedule. Participants’ recommendations to establish an HMO decision support service should be considered.

Key words

evidence-based medicine primary care medical education 



We would like to thank the primary care physicians and course facilitators who took part in the study. In addition, we thank The Galil Center for Medical Informatics and Telemedicine for giving administrative and logistic support. This paper was presented in The Second Israeli National Convention of Qualitative Research Methodologies on June 5th, 2006.

Financial Support

The Israel National Institute for Health Policy and Health Services Research and the Roter Fund (Maccabi Health Services).

Potential Financial Conflicts of Interest

None disclosed.

Ethical Approval

An exemption from the Helsinki Committee [Institutional Review Board (IRB)] of the Emek Medical Center, Afoula, Israel.


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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Kerem Shuval
    • 1
  • Aviv Shachak
    • 2
  • Shai Linn
    • 1
  • Mayer Brezis
    • 4
  • Paula Feder-Bubis
    • 3
  • Shmuel Reis
    • 2
    • 5
  1. 1.School of Public HealthUniversity of HaifaMount Carmel HaifaIsrael
  2. 2.Galil Center for Medical Informatics and Telemedicine and The R&B Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael
  3. 3.School of Public Health and Community MedicineThe Hebrew University of JerusalemJerusalemIsrael
  4. 4.Center for Clinical Quality & SafetyHadassah Hebrew University Medical CenterJerusalemIsrael
  5. 5.Department of Medical Education, The R&B Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael

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