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      Integration of evidence based medicine into the clinical years of a medical curriculum

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          Abstract

          Teaching Evidence Based Medicine (EBM) helps medical students to develop their decision making skills based on current best evidence, especially when it is taught in a clinical context. Few medical schools integrate Evidence Based Medicine into undergraduate curriculum, and those who do so, do it at the academic years only as a standalone (classroom) teaching but not at the clinical years. The College of Medicine at King Saud bin Abdulaziz University for Health Sciences was established in January 2004. The college adopted a four-year Problem Based Learning web-based curriculum. The objective of this paper is to present our experience in the integration of the EBM in the clinical phase of the medical curriculum. We teach EBM in 3 steps: first step is teaching EBM concepts and principles, second is teaching the appraisal and search skills, and the last step is teaching it in clinical rotations. Teaching EBM at clinical years consists of 4 student-centered tutorials. In conclusion, EBM may be taught in a systematic, patient centered approach at clinical rounds. This paper could serve as a model of Evidence Based Medicine integration into the clinical phase of a medical curriculum.

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          Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine.

          T Ruff, M. Green (2005)
          Physicians fail to pursue answers to most of their clinical questions, despite exhortations to practice evidence-based medicine (EBM). While studies have revealed several barriers practicing physicians experience in answering clinical questions, residents may encounter unique obstacles. The authors conducted a qualitative study to explore residents' experience in trying to answer their clinical questions. In 2003, the authors studied a convenience sample of 34 residents, representing 54% of the residents in a university-based internal medicine program. A professional facilitator convened and audiotaped three focus groups with the residents, following a discussion guide. The key question elicited the barriers residents encountered in attempting to answer their clinical questions. A thematic analysis of the transcripts was performed, using the constant comparison method of analysis. Two investigators met after independently analyzing each of the transcripts to compare coding structures, review theme exemplars, and reach consensus for differences. Eight main themes emerged that characterize the EBM barriers, including access to medical information, skills in searching information resources, clinical question tracking, time, clinical question priority, personal initiative, team dynamics, and institutional culture. The analysis suggested a conceptual model in which residents may encounter different barriers in every step of the EBM process. Furthermore, attitudinal or cultural barriers may lead a resident to abandon the pursuit of a question before some of the technical barriers would be encountered. Residents face several EBM barriers, some of which are unique to their status as trainees. While increased informatics training and reliable, rapid, and point-of-care access to electronic information resources remain necessary, they are not sufficient to help residents practice EBM. Educators must also attend to their attitudes toward learning and to the influence of programmatic and institutional cultures.
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            Impact of an evidence-based medicine curriculum based on adult learning theory.

            V Green, Aleksander P J Ellis (1997)
            To develop and implement an evidence-based medicine (EBM) curriculum and determine its effectiveness in improving residents' EBM behaviors and skills. Description of the curriculum and a multifaceted evaluation, including a pretest-posttest controlled trial. University-based primary care internal medicine residency program. Second- and third-year internal medicine residents (N = 34). A 7-week EBM curriculum in which residents work through the steps of evidence-based decisions for their own patients. Based on adult learning theory, the educational strategy included a resident-directed tutorial format, use of real clinical encounters, and specific EBM facilitating techniques for faculty. Behaviors and self-assessed competencies in EBM were measured with questionnaires. Evidence-based medicine skills were assessed with a 17-point test, which required free text responses to questions based on a clinical vignette and a test article. After the intervention, residents participating in the curriculum (case subjects) increased their use of original studies to answer clinical questions, their examination of methods and results sections of articles, and their self-assessed EBM competence in three of five domains of EBM, while the control subjects did not. The case subjects significantly improved their scores on the EBM skills test (8.5 to 11.0, p = .001), while the control subjects did not (8.5 to 7.1, p = .09). The difference in the posttest scores of the two groups was 3.9 points (p = .001, 95% confidence interval 1.9, 5.9). An EBM curriculum based on adult learning theory improves residents' EBM skills and certain EBM behaviors. The description and multifaceted evaluation can guide medical educators involved in EBM training.
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              Extended evaluation of a longitudinal medical school evidence-based medicine curriculum.

              Christine McDonald, T. Florian Jaeger, C. West (2011)
              Evidence-based medicine (EBM) is an important element of medical education. However, limited information is available on effective curricula. To evaluate a longitudinal medical school EBM curriculum using validated instruments. We evaluated EBM attitudes and knowledge of medical students as they progressed through an EBM curriculum. The first component of the curriculum was an EBM "short course" with didactic and small-group sessions occurring at the end of the second year. The second component integrated EBM assignments with third-year clinical rotations. The 15-point Berlin Questionnaire was administered before the course in 2006 and 2007, after the short course, and at the end of the third year. The 212-point Fresno Test was administered before the course in 2007 and 2008, after the short course, and at the end of the third year. Self-reported knowledge and attitudes were also assessed in all three classes of medical students. EBM knowledge scores on the 15-point Berlin Questionnaire increased from baseline by 3.0 points (20.0%) at the end of the second year portion of the course (p < 001) and by 3.4 points (22.7%) at the end of the third year (p < 001). EBM knowledge scores on the 212-point Fresno Test increased from baseline by 39.7 points (18.7%) at the end of the second year portion of the course (p < 001) and by 54.6 points (25.8%) at the end of the third year (p < 001). On a 5-point scale, self-rated EBM knowledge increased from baseline by 1.0 and 1.4 points, respectively (both p < 001). EBM was felt to be of high importance for medical education and clinical practice at all time points, with increases noted after both components of the curriculum. A longitudinal medical school EBM was associated with markedly increased EBM knowledge on two validated instruments. Both components of the curriculum were associated with gains in knowledge. The curriculum was also associated with increased perceptions of the importance of EBM for medical education and clinical practice.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Family Community Med
                Journal ID (iso-abbrev): J Family Community Med
                Journal ID (publisher-id): JFCM
                Title: Journal of Family & Community Medicine
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1319-1683
                ISSN (Electronic): 2229-340X
                Publication date (Print): May-Aug 2012
                Volume: 19
                Issue: 2
                Pages: 136-140
                Affiliations
                [1 ] College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
                [2 ] King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
                [3 ] Department of Family Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
                [4 ] Department of Pediatrics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
                [5 ] Department of Medicine, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
                [6 ] Department of Medical Education, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
                [7 ] King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
                Author notes
                Address for correspondence: Dr. Mazen Ferwana, King Abdul-Aziz Medical City, National Guard Health Affairs, P. O. Box 22490, Mail Code - 3120, Riyadh- 11426, Saudi Arabia. E-mail: drmazen99@ 123456yahoo.com
                Article
                Publisher ID: JFCM-19-136
                DOI: 10.4103/2230-8229.98307
                PMC ID: 3410178
                PubMed ID: 22870419
                SO-VID: 6eea6b0d-8b79-4b55-b108-189a9331e02f
                Copyright © Copyright: © Journal of Family and Community Medicine
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Subject: Medical Education

                ScienceOpen disciplines: Health & Social care
                Keywords: clinical years,medical education,medical curriculum,evidence based medicine
                Data availability:
                ScienceOpen disciplines: Health & Social care
                Keywords: clinical years, medical education, medical curriculum, evidence based medicine

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