The most common sources used by the graduating students to obtain scientific information were; personal lecture notes, fellow students and CDR (Compact Dentistry References) books. About half of the students had good basic knowledge of EBD. A minority of the students referred to valid scientific websites or journal websites to obtain information. Dental students who sensed to possess weaker information retrieval skills showed lower EBD scores and used invalid information sources more frequently.
Taking care of the patient’s oral health and providing the best available treatment is the responsibility of dentists and dental students [11]. Dentists and dental students make clinical decisions daily and in these decisions, they should combine the best scientific evidence available to improve the chances of providing a successful patient care [1].
However, contrary to EB oral health care approach the graduating dental students in the present study preferred to use sources which were easily available, summarized, and easy to read such as personal lecture notes, fellow students and CDR books, but not the evidence-based scientific information. These sources are useful for students at the time of their education and for their exams, however, after graduation these sources have several limitations for appropriate decision making and treatment planning; these sources may not be accurately evidence-based, not updated, and may be based on personal experience or expert opinion.
Similarly, colleagues, the commercial health gate portal for dental practitioners, and personal lecture notes were the most frequently used sources of information among last year dental students at Universities in Finland [2]. Unfortunately, this might be the case among dental instructors too. Iranian faculty members also preferred original textbooks and colleagues when seeking scientific information and rarely used Cochrane library [12]. Dental practitioners also rely more on their own judgment or their colleagues' consultations in their clinical decisions instead of evidence-based databases [13–16].
To overcome uncertainty and variation in clinical decision making, dental students and clinicians should use EB health care method [1]. Firstly, they must know how to articulate answerable questions using problem (P), intervention or exposure (I/E), comparison (C), and outcome (O) method [17]. Secondly, they must know how to search for the best evidence in different electronic databases efficiently. Finally, once the best evidence has been identified, they should know how to critically appraise the evidence [18].
In this study, nearly half of dental students had poor or moderate knowledge of EBD. This finding is in accordance with the results of previous studies among dental students in Tehran [10], Mashhad [7], and dental residents in Kerman [8], illustrated that most Iranian dental students have insufficient basic understanding and knowledge about EBD, however, they do have positive attitude and believe that using EBD is helpful for patient care.
In the present study dental students of Mashhad dental school showed higher EBD scores than dental students of Babol dental school. Although these schools follow the same educational curriculum, there are some notable differences in terms of their educational and research profiles that might explain this finding. However the mean EBD knowledge for both student groups was lower than the good level.
In the same way, previous studies have highlighted that dental and medical students are unfamiliar with EBD or Evidence-Based Medicine and a small minority of them rated their EB related skills as advanced [2–5]. These results indicate that topics such as EBD, critical appraisal of different treatment methods and the important recent scientific information have not been sufficiently enough included in dental curriculums or not implemented adequately [2, 11]. Over the past two decades several valid scientific databases and associations such as Cochrane Oral Health Group, International Association of Dental Research, and Evidence-based Dentistry Network have been developed to assist clinicians in best decision making of oral health care procedures [1].
In Iran, internet has become more accessible and easier to use during the recent years, thus scientific information retrieval and finding of answers are faster and possible among Iranian students and dentists. Also, medical faculties and the Ministry of Health annually invest to provide useful scientific and valid international data bases for students despite their financial limitations. Even though only a smaller proportion of dental students in the present study used Medline or websites of scientific journals to search scientific information, more used those at home compared to the university.
In addition to our students’ lack of fluency in English to search scientific information in international websites, students are mostly busy with clinical practice in the universities, and they are not required to search this information in scientific journals or Medline. Furthermore, this clinical approach in treatment and education disclosed why the least common specialty fields students searched for scientific information were non-clinical fields such as oral pathology and dental public health.
In the present study, two-thirds of the students used internet to search and obtain scientific information, however most of them used invalid websites for information retrieval. Our findings revealed that students who used at least one invalid information source (personal lecture notes, fellow dental students, advertisements brochures) possessed weaker information retrieval skills. In addition, the students with weaker information retrieval skills revealed lower EBD knowledge scores. These findings highlighted the importance and responsibility of dental curriculum planning in improving the students' information retrieval skills as well as their knowledge, attitude, and practice of EBD.
Theoretical education in the field should start in the first years of study and continue to practical courses in later years of study so that the students learn to apply EBD practically in their decision making. In line, medical students who received EBM training and senior students who participated in research activities revealed higher EBM-related knowledge [3]. These findings highlight the importance of adapting health sciences educational curricula with evidence-based concept [1, 3, 19].