Integration of Evidence Based Medicine into a Medical Curriculum

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Abstract

The College of Medicine at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) was established in January 2004. The four-year curriculum was based on the Problem Based Learning (PBL) format and involved the web-based graduate medical program adopted from the University of Sydney, Australia. At KSAU-HS, one additional semester was added to the beginning of this curriculum to prepare the students in English language skills, PBL, Information Technology and Evidence Based Medicine (EBM). EBM is part of the Personal and Professional Development (PPD) theme of the medical curriculum and is integrated into each stage of the medical curriculum. These modifications of the University of Sydney curriculum are presented here as a model of EBM integration into a college of medicine curriculum.

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A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

Khalid Khan, Arri Coomarasamy (2006)

Background A variety of methods exists for teaching and learning evidence-based medicine (EBM). However, there is much debate about the effectiveness of various EBM teaching and learning activities, resulting in a lack of consensus as to what methods constitute the best educational practice. There is a need for a clear hierarchy of educational activities to effectively impart and acquire competence in EBM skills. This paper develops such a hierarchy based on current empirical and theoretical evidence. Discussion EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching. Summary All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field.

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Users' Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the Users' Guides to patient care. Evidence-Based Medicine Working Group.

G H Guyatt, R B Haynes, R Jaeschke … (2000)

This series provides clinicians with strategies and tools to interpret and integrate evidence from published research in their care of patients. The 2 key principles for applying all the articles in this series to patient care relate to the value-laden nature of clinical decisions and to the hierarchy of evidence postulated by evidence-based medicine. Clinicians need to be able to distinguish high from low quality in primary studies, systematic reviews, practice guidelines, and other integrative research focused on management recommendations. An evidence-based practitioner must also understand the patient's circumstances or predicament; identify knowledge gaps and frame questions to fill those gaps; conduct an efficient literature search; critically appraise the research evidence; and apply that evidence to patient care. However, treatment judgments often reflect clinician or societal values concerning whether intervention benefits are worth the cost. Many unanswered questions concerning how to elicit preferences and how to incorporate them in clinical encounters constitute an enormously challenging frontier for evidence-based medicine. Time limitation remains the biggest obstacle to evidence-based practice but clinicians should seek evidence from as high in the appropriate hierarchy of evidence as possible, and every clinical decision should be geared toward the particular circumstances of the patient.

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Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis.

Nadia Khan, Finlay McAlister (2006)

In a recently published meta-analysis, investigators asserted that beta-blockers should not be used to treat hypertension. Because the pathophysiology of hypertension differs in older and younger patients, we designed this meta-analysis to clarify the efficacy of beta-blockers in different age groups. The primary outcome was a composite of stroke, myocardial infarction and death. We identified randomized controlled trials that evaluated the efficacy of beta-blockers as first-line therapy for hypertension in preventing major cardiovascular outcomes. Both authors independently evaluated the eligibility of all trials. Trials enrolling older (mean age at baseline > or = 60 years) patients were separated from those enrolling younger (mean age < 60 years) patients. Data were pooled using a random effects model. Our analysis incorporated data from 145 811 participants in 21 hypertension trials. In placebo-controlled trials, beta-blockers reduced major cardiovascular outcomes in younger patients (risk ratio [RR] 0.86, 95% confidence interval [CI] 0.74-0.99, based on 794 events in 19 414 patients) but not in older patients (RR 0.89, 95% CI 0.75-1.05, based on 1115 events in 8019 patients). In active comparator trials, beta-blockers demonstrated similar efficacy to other antihypertensive agents in younger patients (1515 events in 30 412 patients, RR 0.97, 95% CI 0.88-1.07) but not in older patients (7405 events in 79 775 patients, RR 1.06, 95% CI 1.01-1.10), with the excess risk being particularly marked for strokes (RR 1.18, 95% CI 1.07-1.30). beta-blockers should not be considered first-line therapy for older hypertensive patients without another indication for these agents; however, in younger patients beta-blockers are associated with a significant reduction in cardiovascular morbidity and mortality.

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Author and article information

Journal

Journal ID (nlm-ta): Med Educ Online

Journal ID (publisher-id): MEO

Title: Medical Education Online

Publisher: Medical Education Online

ISSN (Electronic): 1087-2981

Publication date (Electronic): 20 September 2009

Publication date Collection: 2009

Volume: 14

Electronic Location Identifier: 15

Affiliations

[* ]College of Medicine, King Saud bin Abdualziz University for Health Sciences, Riyadh, Saudi Arabia

[† ]King Abdullah International Medical Research Center, Riyadh, Saudi Arabia

[‡ ]Department of Family medicine, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

[§ ]Department of Pediatrics, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

[ǁ ]Department of Pathology & Laboratory Medicine, King Abdualziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia

Author notes

Correspondence Ali Hajeer, PhD, FRCPath, College of Medicine, King Saud bin Abdualziz University for Health Sciences, P.O. Box 22490, Riyadh 11426, Saudi Arabia. Phone: 00966-1-252-0088 ext: 47249. Fax: 00966-1-252-0130. E-mail: hajeera@ 123456ksau-hs.edu.sa

Article

Publisher ID: MEO-14-F0000225

DOI: 10.3885/meo.2009.F0000225

PMC ID: 2779624

PubMed ID: 20165529

SO-VID: 6a21225e-3abd-4e42-92ae-1f320c1f79b7

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Material in Medical Education Online is licensed under a Creative Commons Attribution-Share Alike 3.0 United States License.

Integration of Evidence Based Medicine into a Medical Curriculum

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Journal of Medical Education Research

Most cited references 12

A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

Users' Guides to the Medical Literature: XXV. Evidence-based medicine: principles for applying the Users' Guides to patient care. Evidence-Based Medicine Working Group.

Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis.

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