aka: EBP flame wars and journal articles used as weapons of mass destruction
aka: How to convince people to frolic in the field of research with you by holding a flower to their nose instead of a gun to their head
aka: All great things are built upon a foundation of solid relationships
aka: Which matters more: facts or people’s feelings? … and I’m just going to answer that question for you and say “both”
People reading this post likely fall into one of two categories: 1) You know exactly why I’m writing this, and you already have your “preach hands” up, or 2) You have no idea what I’m talking about, or why I would even open this discussion. If you fit in the latter category, I hope I can coherently explain the issue. I’ll give it a whirl...
Let’s start with the backstory:
Once upon a time, the field of speech–language pathology realized that in order to act in our clients’ best interests, we need to be using evidence-based practice (of course this has been an interdisciplinary, international thing, but for now we’ll discuss it only as it applies within our field). Traditionally, SLPs have done well with the clinical expertise and clients’ needs portions of this. They’ve done less well with taking research evidence into consideration. Why would that be? Perhaps because the research is so far away from us. It’s hard to get, it’s hard to wade through, and it’s time-consuming to interpret. Simply put, there are high (and numerous) barriers between clinicians and the evidence, with two of the big ones being access and utility. And to-date, we haven’t been all that honest with each other about those barriers. Ultimately, this lack of communication, lack of frankness, and abysmal acknowledgment of clinical reality has impeded our ability to make the “research” corner of EBP realistic and achievable.
What would you say is the biggest barrier to clinicians knowing the research?
Most folks say “time”. Here and here they cite time as the biggest (or primary) barrier. Any time I go to a conference and participate in an EBP talk and somebody asks the audience this question, they always say time. Any time I go to a conference and nobody takes the question beyond time, I start to get a little cranky. Here’s why:
Time barriers are real, for sure. But “time” is a surface issue that hides what’s really going on.
And we need to start talking about the real problems.
What are the real problems? Clinicians, do an exercise with me, and you’ll see what I mean:
***NOTE that the time I just gifted you, above, barely scratches the surface. Brackenberry et al., 2008 suggest it takes 3–7 hours to pose a question, research it, read the evidence, and pose a solution.
OK, so what’s this BIG, under-acknowledged barrier?