Oberklaid F

Centre for Community Child Health

Royal Children’s Hospital, Melbourne, Australia


Objective: To investigate reasons for the apparent gap between research evidence and practice, and determine barriers that prevent practitioners to utilise evidence based practice.

Methods: Review of literature regarding effectiveness of the various methods to change clinical practice including continuing education, practice incentives, clinical guidelines, financial incentives, peer review, and face-to-face meetings.

Results: Significant barriers exist in our attempts to disseminate research findings and clinical evidence of effectiveness so that they are taken up by practitioners.  There is a difficulty in communicating research findings in practical ways so that it is perceived as relevant to clinical practice.  Significant barriers exist to changing clinical practice including the organisation of service delivery at a macro and micro level, the lack of incentives for practitioners to change, practitioner suspicion of research findings and natural resistance to change.  There is little evidence of effectiveness of most traditional teaching methods (eg. lectures, written materials) to effect any change in practice.  Despite the popularity in recent years of clinical guidelines, there is little evidence that they have done much to systematically change practice.

Conclusions: Despite the inherent attractiveness of providing continual medical education to practitioners, there remain formidable challenges that need to be addressed and overcome if we are to meet the goal of ensuring evidence based clinical practice.