The perceptions and experiences of Chiropractic Master’s students on practicing evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal

Abstract

Evidence-based practice (EBP) integrates the best available research evidence in conjunction with clinical expertise with the consideration of patient values. A well-trained clinician should pose clinically relevant questions and access the clinically relevant literature to find, appraise, and use the best valuable evidence in routine clinical care. Patients who receive evidence-based therapy have better outcomes in comparison to patients who do not. Globally, EBP is accepted as a basis of healthcare professional education, which was initially used in medicine, but now extends to allied health professions. In order to achieve the best patient outcomes, healthcare professions should effectively incorporate adequate knowledge, skills and attitudes towards EBP into education programmes. The implementation of EBP is regarded as a key competence for the improvement of healthcare quality. Numerous professions have implemented EBP, such as nursing, physiotherapy, occupational therapy, social care, pharmacy, physical therapy, dietetics, podiatry, radiography, orthotics, speech and hearing therapy, psychology and chiropractic. Evidence-based practice has had an increasing impact on chiropractic education and its implementation in chiropractic care. The importance of EBP is essential as its implementation is a requirement at the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC). Students are required to use EBP when managing and treating patients during their clinical practicum and, thus, it is essential that students are knowledgeable in EBP and know how to use it adequately. Aim of the study The aim of this study was determine the perceptions and experiences of registered Chiropractic Master’s students on the implementation of evidence-based practice during their clinical practicum at a teaching clinic in KwaZulu-Natal, South Africa. Methodology This study utilised a qualitative, exploratory and descriptive design. Purposive sampling was used, interviewing 14 Chiropractic Master’s students who have been clinically active for more than four months at a chiropractic teaching clinic in KwaZulu-Natal. Their perceptions and experiences with regard to the implementation of EBP were obtained through semi-structured interviews, which consisted of three key questions, encouraged by relevant probes. The data collected were stored electronically and then transcribed verbatim. Thereafter, the transcripts were coded and analysed by the researcher in order to identify themes along with relevant subthemes. The coded data were then interpreted by the researcher using the previously identified themes and sub-themes. Results There were four main themes identified in this study, namely perceptions and necessity regarding the roles of EBP; undergraduate education and its role in the implementation of EBP; the importance of clinical experience in the implementation of EBP; and the implementation of EBP. Overall, students had a positive perception with regard to EBP with some students reporting limitations to its practice, along with positive perceptions. The students believed that the chiropractic training at the DUT CDC provided a solid foundation but a lack of training in multiple aspects was found. These aspects are discussed comprehensively, including the insufficient training in theoretical and clinical aspects, as well as for pre-clinical preparation. In addition, limitations and barriers were identified, as well as measures of improvement in order to enhance the implementation of EBP were suggested. Conclusion In South Africa, this study is the first to explore the perceptions and experiences of Chiropractic Master’s students on the practice of EBP at a teaching clinic in KwaZulu Natal. The perceptions and experiences were based on various aspects, such as knowledge, application, skills, proficiency, confidence, support structures, training and challenges. Although Chiropractic Master’s students had positive perceptions regarding the implementation of EBP and found the chiropractic training at the DUT to have provided a solid foundation, there were suggested methods of improvement for the chiropractic curriculum to enhance the implementation of EBP. A lack of undergraduate training regarding EBP was one of the key factors that students found to have hindered a more efficient practice of an evidence-based approach. Therefore, it is recommended that the findings of this study be of aid to the Durban University of Technology Chiropractic Department to enhance the quality of the chiropractic curriculum by re-evaluating the context in which the concept of an evidence-based approach was set out in order to encourage EBP by students and consider a different, more coherent method of implementation.