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      A clinically integrated curriculum in Evidence-based Medicine for just-in-time learning through on-the-job training: The EU-EBM project

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          Abstract

          Background

          Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners.

          Methods

          A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process.

          Results

          We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed.

          Conclusion

          The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice.

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          Most cited references25

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          Evidence-based medicine.

          Evidence-based medicine, whose philosophical origins extend back to mid-19th century Paris and earlier, is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that we individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatment and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer. Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by external evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best external evidence, practice risks becoming rapidly out of date, to the detriment of patients. The practice of evidence-based medicine is a process of life-long, self-directed learning in which caring for our own patients creates the need for clinically important information about diagnosis, prognosis, therapy, and other clinical and health care issues, and in which we (1) convert these information needs into answerable questions; (2) track down, with maximum efficiency, the best evidence with which to answer them (whether from the clinical examination, the diagnostic laboratory from research evidence, or other sources); (3) critically appraise that evidence for its validity (closeness to the truth) and usefulness (clinical applicability); (4) integrate this appraisal with our clinical expertise and apply it in practice; and (5) evaluate our performance.
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            Instruments for evaluating education in evidence-based practice: a systematic review.

            Evidence-based practice (EBP) is the integration of the best research evidence with patients' values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness. To appraise, summarize, and describe currently available EBP teaching evaluation instruments. We searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument. Two raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes. Of 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures. Instruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.
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              Educational strategies in curriculum development: the SPICES model.

              Six education strategies have been identified relating to the curriculum in a medical school. Each issue can be represented as a spectrum or continuum: student-centred/teacher-centred, problem-based/information-gathering, integrated/discipline-based, community-based/hospital-based, elective/uniform and systematic/apprenticeship-based. The factors supporting a more towards each end of the continuum are presented for each strategy. Newer schools tend to be more to the left on the continuum, established schools more to the right. Each school, however, has to decide where it stands on each issue and to establish its own profile. This SPICES model of curriculum strategy analysis can be used in curriculum planning or review, in tackling problems relating to the curriculum and in providing guidance relating to teaching methods and assessment.
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                Author and article information

                Journal
                BMC Med Educ
                BMC Medical Education
                BioMed Central
                1472-6920
                2007
                27 November 2007
                : 7
                : 46
                Affiliations
                [1 ]Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
                [2 ]Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, The Netherlands
                [3 ]CASPe (CASP Espana), Joaquin Orozco 6, 1°-F, 03006 Alicante, Spain
                [4 ]Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK
                [5 ]The University of Birmingham, Edgbaston, Birmingham B15 2TG, UK
                [6 ]Agency for Quality in Medicine, Weglelystrasse 3, 10623 Berlin, Germany
                [7 ]University of Pécs, Department of Paediatrics, József Attila u. 7, Pécs, H-7623, Hungary
                [8 ]TUDOR, University of Szeged, Albert Szent-Gyorgyi Medical and Pharmacological Centre, Somogyi Bela ter 1, Szeged, H-6725, Hungary
                [9 ]CASPolska, 30-347 Krakow, ul. Wadowicka 3, Poland
                [10 ]Universitá Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29100 Piacenza, Italy
                [11 ]Basel Institute for Clinical Epidemiology, Hebelstrasse 10, CH 4031 Basel, Switzerland
                Article
                1472-6920-7-46
                10.1186/1472-6920-7-46
                2228282
                18042271
                545536a0-6f6e-41ad-9863-e56845eef37c
                Copyright © 2007 Coppus et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 May 2007
                : 27 November 2007
                Categories
                Correspondence

                Education
                Education

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