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Background: General practitioner (GP) trainees state that their trainers are not consistent in using evidence-based medicine (EBM) or are even dismissive of it. As trainers are important role models in the Dutch GP training system this could have a large influence on the EBM training of GP trainees. Aim: To establish the motivations and barriers of Dutch GP trainers in using EBM. Methods: A questionnaire on personal characteristics, knowledge, skills (Berlin, score 0-15) and attitude (McColl, VAS score 0-100), and statements about EBM barriers were presented to 106 GP trainers. Additionally, three focus group sessions with trainers ( n = 30) were held. Results: Knowledge and skills were less than half correct (mean 6.1, standard deviation (SD) 2.9); the overall score on attitude was 58.8 (SD 9.4). Factor analysis showed four categories of barriers: EBM competence (mean 3.5 (SD 0.8)), search activities (mean 3.5 (SD 0.8)), motivation (mean 3.8 (SD 0.7)) and time (mean 2.5 (SD 0.9)). After analysis of the focus group sessions, five categories of motivations and barriers predominated: EBM competence, attitude and behaviour, sources, time and logistics. Conclusion: GP trainers experience motivations in EBM; however, these motivations can also be barriers, depending on the trainer's level of knowledge and attitude. [ABSTRACT FROM AUTHOR]

E. te Pas et al. respond to a letter to the editor about their article "Factors Influencing the EBM Behaviour of GP Trainers: A Mixed Method Study", which was concerned with evidence based medicine.

Background: Continuing Professional Development (CPD) and Faculty Development (FD) courses have been designed in the expectation that a cascade effect will occur, consisting of a conveyance of information from the courses to clinical trainers to daily practice and/or to trainees by means of role modeling., Purpose: The aims of this study were to gain insight into factors that encourage clinical trainers to incorporate what they have learned in CPD/FD into their role model function and the factors that influence conveyance from master to apprentice., Method: We conducted a qualitative study using semi-structured interviews with GP trainers and their trainees., Results: Twenty-four GP trainers who completed a CPD/FD course and sixteen of their trainees participated in the study. Analysis of their statements enabled the identification of factors that affect the amplification of the competences of clinical trainers and their awareness of being a role model, the applicability in training practice and conveyance to the trainee., Conclusions: As a result of interactions between the trainer, trainee and patient, it seems more accurate to represent the conveyance of competences from master to apprentice using the image of a whirlpool rather than a cascade, with the influential factors and interactions functioning as filters, causing a decline in the effectiveness of CPD/FD. Using the filters as a basis for turning-points for improvements around the whirlpool could increase the effectiveness of CPD/FD.

Background: Clinical workplace-based learning has been the means to becoming a medical professional for many years. The importance of an adequate patient mix, as defined by the number of patients and the types of medical problems, for an optimal learning process is based on educational theory and recognised by national and international accreditation standards. The relationship between patient mix and learning in work-based curricula as yet remains unclear., Aim: To review research addressing the relationship between patient mix and learning in work-based clinical settings., Method: The search was conducted across Medline, Embase, Web of Science, ERIC and the Cochrane Library from the start date of the database to July 2011. Original quantitative studies on the relationship between patient mix and learning for learners at any level of the formal medical training/career were included. Methodological quality was assessed and two reviewers using pre-specified forms extracted results., Results: A total of 10,420 studies were screened on title and abstract. Of these, 298 articles were included for full-text analysis, which resulted in the inclusion of 22 papers. The quality of the included studies, scored with the Medical Education Research Study Quality Instrument (MERSQI), ranged from 8.0 to 14.5 (of 18 points). A positive relationship was found between patient mix and self-reported outcomes evaluating the progress in competence as experienced by the trainee, such as self-confidence and comfort level. Patient mix was also found to correlate positively with self-reported outcomes evaluating the quality of the learning period, such as self-reported learning benefit, experienced effectiveness of the rotation, or the instructional quality. Variables, such as supervision and learning style, might mediate this relationship. A relationship between patient mix and formal assessment has never been demonstrated., Conclusion: Patient mix is positively related to self-reported learning outcome, most evidently the experienced quality of the learning programme.