Finding and appraising evidence.

Surgeons have tended to regard evidence-based medicine with a degree of skepticism. A variety of reasons for this have been proposed,ranging from the surgical personality to the nature of the research questions that occur when studying surgical treatment. The relative paucity of randomized trials of surgical treatment has been noted by many investigators, and there has been considerable debate about whether this reflects poorly on the scientific education of the surgical community or points to special problems in applying this methodology in this discipline. This debate has matured over the last 10 years, and there is now greater understanding of the factors that make surgical operations difficult subjects for randomized trials; on the other hand, such trials are being done now more than ever before.