Evidence-Based Practice in 2025: Filling the Knowledge-to-Practice
Posted:
2025-09-15
What's happening?
Dietitians know, and care about evidence-based practice (EBP) - but do they apply it regularly in their jobs? Some evidence (1) has suggested that allied health professionals, including dietitians, may begin to feel uncomfortable (or out-of-date) applying their EBP skills within five years of entering clinical practice, “particularly for those activities involving critical analysis of published studies” (1). The PEN Team asked: does this alleged discomfort stop dietitians from applying EBP?
Has this question been studied?
The short answer is, not well. Very little research has been conducted on dietitians' knowledge and implementation of EBP standards. A recent systematic review found only 12 cross-sectional studies (including 1065 participants in total) that examined dietitian competency in various EBP skills (2). Dietitians (or international equivalents) and dietetic interns from six countries (United States, United Kingdom, Sweden, Pakistan, Taiwan, and Australia) were included.
What did this systematic review find (2)?
Based on the PEN Team’s analysis:
Reporting quality was poor across studies; for example, only one study used an objective measurement tool in their assessment.
None of the studies examined every EBP skill that the authors defined as relevant (creating PICO questions, literature searches, critical appraisal, understanding/ interpreting effect size, understanding/ interpreting certainty of evidence, and judging whether study results are applicable to individuals considering their values and preferences) (2).
Taking in the above analysis, the review did find:
Dietitians lacked skills at finding the best available evidence.
Dietitians lacked confidence in their ability to critically appraise scientific studies.
Three studies found that only 55-60% of participants were confident in their ability to critically appraise scientific literature, although one study of specialist dietitians found that 86% of participants were confident in this ability. All evidence was self-reported; no studies objectively measured participants’ evidence appraisal skills.
Dietitians had low confidence and objectively poor ability at interpreting study results.
Three studies subjectively measured dietitians’ confidence in interpreting study results, one of which found that 63% of participants were confident and two which found that 22-38% of participants were confident. One small study of 14 dietetic interns found that when measured objectively, all participants had inadequate knowledge of how to interpret the results of a scientific study.
Dietitians were confident in applying the study results.
The PEN System can fill the evidence gap
Although little evidence has been conducted on the topic, dietitians appear to be becoming skilled at implementing study results and are willing to incorporate evidence into their practice. However, without the ability to find the best available evidence, appraise study quality and understand study results, the value of this skill is limited.
The PEN System,
now 20 years old, continues to fill the important gap between knowledge and practice. It is a knowledge translation tool where the PEN Team finds and appraises the best available evidence to make nutrition recommendations and develop practice tools that you can use in your practice to improve the health outcomes of your patients and clients.
For Additional Content:
References
Klaic M, McDermott F, Haines T. How soon do allied health professionals lose confidence to perform EBP activities? A cross-sectional study. J Eval Clin Pract. 2019 Aug;25(4):603-612. doi: 10.1111/jep.13001. Epub 2018 Sep 4. PMID: 30178627. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/30178627/
Ghosh NR, Esmaeilinezhad Z, Zając J, Creasy RA, Lorenz SG, Klatt KC, et al. Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review. J Nutr. 2024 Apr;154(4):1414-1427. doi: 10.1016/j.tjnut.2023.12.044. Epub 2023 Dec 29. PMID: 38159813; PMCID: PMC11347811. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/38159813/
Johnston BC, Seivenpiper JL, Vernooij RWM, de Souza RJ, Jenkins DJA, Zeraatkar D, Bier DM, Guyatt GH. The Philosophy of Evidence-Based Principles and Practice in Nutrition. Mayo Clin Proc Innov Qual Outcomes. 2019 May 27;3(2):189-199. doi: 10.1016/j.mayocpiqo.2019.02.005. PMID: 31193887; PMCID: PMC6543447. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/31193887/
