The need for education in evidence-based orthopedicsAn international survey of AO course participants

BACKGROUND: As evidence-based practitioners, surgeons need to understand study methodology to critically appraise and conduct research. OBJECTIVE: To determine current understanding of study methodology and critical appraisal among participants at an international educational meeting. METHODS: We surveyed participants attending the 76th and 77th AO Course (December 2002) in Davos, Switzerland. We obtained information regarding participant age, gender, clinical and research experience, subspecialty area and respondents' roles in the AO course. The survey questions were formatted into three areas: evidence-based orthopedics, randomization and blinding issues. RESULTS: 532 participants completed the questionnaire. They represented 78 countries, the majority of which (31%) were from German-speaking countries. A greater proportion of participants trusted randomized controlled trials (89%) and meta-analyses of randomized trials (81%) when compared with case series and case reports. 60 respondents (11%) had never heard of the term "randomization" as a study design method to limit bias, and 114 respondents (21%) had never heard of the term "blinding" as a method of reducing bias in surgical research. When those who had heard of blinding were asked to define the term "double-blind", 20 different definitions resulted. Having completed the survey, nine-tenths of the respondents endorsed the need for training of surgeons in research methodology.