Table 2

Instruments and measurements used for EBM behaviour, EBM attitude and EBM knowledge

OutcomeMeasurement
InstrumentDataScore per itemOutcomeScoreNumeratorDenominator
EBM behaviourGuideline adherenceValidated instrument that assesses EBM behaviour of GP trainees by measuring rational guideline adherence during patient consultations, thereby allowing motivated deviation in individual patients on 59 different management decisions (diagnosis N=17, therapy N=20, referral N=22) for 23 conditions as described in 27 different Dutch GP clinical practice guidelines26Copied from the EMRs: gender, age, reason for encounter, medical history, results of physical examination, diagnosis and treatment or referral−1Not in accordance with the guideline and no reason mentioned to deviate from itComplete adherence
in patient consultations		−1 to 1All patient consultations with score 1 on all management decisions in that patient consultationAll patient consultations assessed with the instrument
All decisions
in patient management		All management decisions with score 1All management decisions assessed with the instrument
0Debatable if in accordance with the guideline due to insufficient or contradicting informationDiagnostic decisions
in patient management		All diagnostic management decisions with score 1All diagnostic management decisions assessed with the instrument
Therapeutic decisions
in patient management		All therapeutic management decisions with score 1All therapeutic management decisions assessed with the instrument
1In accordance with the guideline or not in accordance but with rational motivationReferral decisions
in patient management		All management decisions on referral with score 1All management decisions on referral assessed with the instrument
Information-seeking behaviourLogbookThe presence of a clinical query, the presence of a search, resource used to search, and retrieval of an answer1YesQueries per patient 0–1All clinical queriesAll patient contacts
0NoPerformed search per clinical queryAll performed searchesAll queries
Performed search in evidence-based resources per clinical query*All performed searches in evidence-based resourcesAll queries
Retrieved answers per performed searchAll retrieved answersAll performed searches
Retrieved answers per performed search in evidence-based resources*All retrieved answersAll performed searches in evidence-based resources
EBM attitudeValidated questionnaire with 7 questions on attitude (with a visual analogue scale from 0 to 100) of the translated version of the McColl questionnaire15–170–100EBM attitude0–100Sum of all scoresAll items scored×100
EBM knowledgeValidated questionnaire on EBM knowledge270–1EBM knowledge0–50NANA

  • *Evidence-based resources: guidelines, PubMed and preappraised bibliographic databases (such as Clinical Evidence, TRIP, Cochrane).

  • EBM, evidence-based medicine; EMR, electronic medical record; GP, general practice; NA, not available.