=Paper= {{Paper |id=Vol-2656/paper6 |storemode=property |title=Evidence-Based Medicine and Computer Skills of Medical Professionals in Bulgaria (short paper) |pdfUrl=https://ceur-ws.org/Vol-2656/paper6.pdf |volume=Vol-2656 |authors=Nikoleta Leventi,Stefan Velikov,Antoniya Yanakieva }} ==Evidence-Based Medicine and Computer Skills of Medical Professionals in Bulgaria (short paper)== https://ceur-ws.org/Vol-2656/paper6.pdf

Evidence-Based Medicine and Computer Skills of
Medical Professionals in Bulgaria

Nikoleta Leventi1, Stefan Velikov1 and Antoniya Yanakieva1
1
Medical University – Sofia, Faculty of Public Health, Dept. HTA, Sofia, Bulgaria
n.leventi@foz.mu-sofia.bg

Abstract. The aim of this study is to demonstrate medical professionals’ opinion
about integration of Evidence-Based Medicine (EBM) discipline into medical
curriculum, in Bulgaria, and the relation with their computer skills. Evidence
is necessary in medicine. For medical professionals is important to have the
appropriate computer skills, in order to search and find the best available evidence
in their daily practice. EBM is a discipline that will provide them with tools useful
in the management of patient.
The survey was conducted among medical professionals included physicians,
dentists, nurses, midwives, and physiotherapists. A questionnaire was used in
order to achieve the purpose of the study. In this paper, we include survey results
information, covering the application of EBM in medical professional’s daily
practice and demographic characteristics.
Analysis of the data demonstrates the need of integration EBM discipline in medical
education. Clinical decisions in medicine must be based on values and evidences.
Medical professionals with good computer skills and using EBM in everyday
practice can reach the best evidences.

Keywords: EBM, computer skills, medical professional education.

1 Introduction
The first appearance of the term EBM was in a publication in the American
College of Physicians’ Journal Club by Gordon Guyatt in 1991 [1]. EBM is
defined by David Sackett as “the conscientious, explicit, and judicious use of
current best evidence in making decision about the care of individual patients” [2].
Conceptually EBM involves three fundamental principles. First, optimal clinical
decision making requires awareness of the best available evidence, which ideally
comes from systematic summaries. Second, EBM provides guidance to decide
whether evidence is more or less trustworthy and third evidence alone is never
sufficient to make a clinical decision. Decision makers must always trade off
the benefits and risks, burden, and costs associated with alternative management
strategies and in doing so, consider their patients unique predicament, values, and
preferences [3].

Copyright © 2020 for this paper by
62 its authors. Use permitted under
Creative Commons License Attribution 4.0 International (CC BY 4.0).
The practice of EBM includes 5 steps:
1. to formulate an answerable question (about therapy, diagnosis, prognosis and
prevention),

2. search and find the best evidence, with which to answer that question,

3. critically appraising the evidence for its validity (closeness to the truth), impact
(size of effect), and applicability,

4. apply the results and integrate them with the clinical expertise and patient’s
values and preferences, and

5. evaluate the efficiency and effectiveness in executing 1 – 4 steps and find ways
to improve them for next time [4].
Due to Internet technology, the increasing volume of new literature, and
medical information systems and platforms, including wide spread applications
for information gathering [5] finding useful evidence is a big challenge for
health professionals. The practice of EBM with the five steps can help medical
professionals to be more productive while updating their knowledge. Computer
skills are essential for medical professionals. They help to navigate through
existing EBM resources and find the current best evidence. This is the way to
deal with the changing information explosion

2 Methodology
In this paper, we show the results from a study focused on the integration of EBM
in medical curriculum in Bulgaria, conducted from June to December 2018.
The methodology used in this study is based on a questionnaire among medical
professionals (physicians, dentists, nurses, midwives and physiotherapists).
Completed questionnaires were received from 311 medical professionals. Of the
respondents 38% were nurses, 36% physicians, 12% dentists, 12% midwives,
and 3% physiotherapists. The questionnaire contained three sections and
included total 47 questions. The collected information was anonymous and all
the participants were volunteers.
The first section of the questionnaire included 14 questions related to
demographic characteristics and asked participants to describe professional and
personal characteristics such as age, nationality, computer skills, etc. The second
section of the questionnaire included questions about medical professional’s
attitude towards EBM. The total number of questions in this part was 21. Finally,
the last (third) part of the questionnaire asked responders about the application of
EBM into their every-day clinical practice.
The majority of the questions were formulated as closed questions, but open

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questions were as well included. Statements related to closed questions were
given a range for the answer in:
 Yes / No
 Yes, No, “ I cannot evaluate”
 “strongly agree”, “I agree “, “I can not evaluate”, “disagree”, and
“strongly disagree”
In this article, we partially present the results of the first section of the
questionnaire, related to demographic results about the computer skills of the
medical professionals; and how they evaluate this knowledge. We also demonstrate
results related to the impact of computer skills level on the application of EBM in
medical professionals’ daily practice.

3 Results
Completed questionnaires were received from 311 medical professionals. The
results of the survey show that the majority of respondents were women 73%,
and 27% men.

Figure 1: Respondents distribution per gender.

It is worth mentioning two questions related to medical professionals
computer skills and how they evaluated their computer competence. Among
medical professionals, 97% reported computer skills and only 3% did not report
such a competence.

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Figure 2: Medical professionals’ competence in computer skills.

The interesting point of the demographics information is data which
demonstrates that 37% of surveyed participants rate their computer skills as good,
31% consider it average, 26% consider it very good, and only 5% rate it as initial.

Figure 3: Medical professionals’ computer skills level rating (for positive answer in computer
skills competences).

The relationship between the level of computer skills and the use of EBM in
everyday practice was analyzed (Fig. 4). Fisher’s exact test shows a statistically
significant relationship with p = 0.001 <0.05. The results show that in the “very
good” category, in terms of level of computer skills, those who believe that learning
more about EBM would be useful in their daily work is 75.3%, which is three
times more than those who believe the opposite or can not evaluate. Therefore,
a good level of computer skills would contribute to better implementation of
evidence-based medicine and the application of good medical practices.

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Figure 4: Relation between medical professionals’ computer skills level and the application of
EBM in their daily practice.

Finally, in relation to the main steps of EBM, the relationship is much
stronger in the groups with low and medium levels of competence. Pierson’s χ2
test found a statistically significant relationship with a significance level of p =
0.032 <0.05 and χ2 = 13.811. The results (Fig. 5) show that in the low and medium
computer skills groups, those who do not know or are not sure about the main
EBM steps are between 75% and 85%, which is three, four times more than those
who believe they are familiar with the EBM steps.

Figure 5: Relation between medical professionals’ computer skills level and their familiarity with
the EBM steps.

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Conclusions
In conclusion, from the conducted research we see that experienced medical
professionals address clinical questions, which need to be based on the current
best evidence, in order to optimally, treat patients. EBM helps, health providers
to make an efficient and effective medical literature searching and answer these
questions. Medical professionals’ computer skills are essential for the integration
of EBM in everyday practice. Efforts should be put in both introducing EBM as a
discipline in medical curricula and improving medical professionals’ knowledge
of computer skills.

References
1. Guyatt G., Evidence-based medicine. ACP J Club (Ann Intern Med), 1991; 114 (suppl. 2):
A-16, 1991.
2. Sackett DL, Rosenberg WM, Gray J., Evidence-based medicine: what it is and what it isn’t.
BMJ: British Medical Journal 1996; 312 (7023): 71. 1996.
3. Guyatt G., Rennie D., O. Meade M., Cook D., Users’ Guide to medical Literature, 3-rd edition,
Mc Graw Hill Education, New York, ISBN: 978-0-07-180872-9, 2015.
4. Straus S., Glasziou P., Richardson W.S., Haynes R. B., Evidence-based medicine: How to
practice and teach it, 4-th edition, Churchill Livingstone Elsevier, Edinburg, ISBN: 978-0-
7020-3127-4, 2011.
5. I. Patias, V. Georgiev, Mobile Medical Applications: From Cloud-oriented to Cloud Ready,
Proceedings of the Eleventh Mediterranean Conference on Information Systems, Publisher:
Association for Information Systems (AIS), pages:1-11, Ref, AIS eLibrary, 2017.