Abstract
Objective
To develop and implement an evidence-based medicine (EBM) curriculum and determine its effectiveness in improving residents’ EBM behaviors and skills.
Design
Description of the curriculum and a multifaceted evaluation, including a pretest-posttest controlled trial.
Setting
University-based primary care internal medicine residency program.
Participants
Second-and third-year internal medicine residents (N=34).
Interventions
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.
Measurements and main results
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).
Conclusions
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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References
Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA. 1992;268:2420–5.
Sackett DL, Rosenberg WMC. The need for evidence-based medicine. J R Soc Med. 1995;88:620–4.
Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient medicine is evidence based. Lancet. 1995;346:407–10.
Ayanian JŽ, Hauptman PJ, Guadagnoli E, Antman EM, Pashos CL, McNeil BJ. Knowledge and practices of generalist and specialist physicians regarding drug therapy for acute myocardial infarction. N Engl J Med. 1994;331:1136–42.
Brand DA, Newcomer LN, Freiburger A, Tian H. Cardiologists’ practices compared with practice guidelines: use of beta-blockade after acute myocardial infarction. J Am Coll Cardiol. 1995;26: 1432–6.
Soumerai SB, McLaughlin TJ, Spiegelman D, Hertzmark E, Thibault G, Goldman L. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA. 1997;277: 115–21.
Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985;103:596–9.
Osiobe SA. Use of information resources by health professionals: a review of the literature. Soc Sci Med. 1985;21:965–73.
McKibbon KA, Haynes RB, Walker-Dilks CJ, et al. How good are clinical MEDLINE searches? A comparative study of clinical end-user and librarian searches. Comput Biomed Res. 1990;23:583–93.
Weiss ST, Samet JM. An assessment of physician knowledge of epidemiology and biostatistics. J Med Educ. 1980;55:692–7.
Berwick DM, Fineberg HV, Weinstein MC. When doctors meet numbers. Am J Med. 1981;71:991–8.
Barondess JA. The future physician: realistic expectations and curricular needs. J Med Educ. 1981;56:381–9.
Rafuse J. Evidence-based medicine means MDs must develop new skills, attitudes, CMA conference told. Can Med Assoc J. 1994; 150:1479–80.
Accreditation Council for Graduate Medical Education. Program requirements for residency education in internal medicine: special educational requirements. In: The Graduate Medical Education Directory, 1996–97. Chicago, Ill: American Medical Association: 1996:79.
Physicians for the twenty-first century: report of the project panel on the general professional education of the physician and college preparation for medicine. J Med Educ. 1984;59(pt 2):127–8, 155–67.
Cullinan TR. Teaching concepts in epidemiology. J Epidemiol Community Health. 1980;34:201–3.
Mulvihill MN, Wallman G, Blum S. A seven year retrospective view of a course in epidemiology and biostatistics. J Med Educ. 1980; 55:457–9.
Knapp RG, Miller MC. Clinical relevance: an issue in biostatistical training of medical students. Med Educ. 1987;21:32–7.
Radack KL, Valanis B. Teaching critical appraisal and application of medical literature to clinical problem solving. J Med Educ. 1986;61:329–31.
Bennett KJ, Sackett DL, Haynes RB, Neufeld VR, Tugwell P, Roberts R. A controlled trial of teaching critical appraisal of the literature to medical students. JAMA. 1987;257:2451–4.
Landry FJ, Pangaro L, Kroenke K, Lucey C, Herbers J. A controlled trial of a seminar to improve medical student attitudes toward, knowledge about, and use of the medical literature. J Gen Intern Med. 1994;9:436–9.
Linzer M, Mercando A, Hupart KH. Role of a medical journal club in residency training. J Med Educ. 1986;61:471–3.
Sidorov J. How are internal medicine residency journal clubs organized and what makes them successful? Arch Intern Med. 1995;155:1193–7.
Linzer M, DeLong ER, Hupart KH. A comparison of two formats for teaching critical reading skills in a medical journal club. J Med Educ. 1987;62:690–2.
O’Sullivan PS, Jeremiah J, Wartman SA. Learner centered journal club teaches residents more about assessing the medical literature. Clin Res. 1991;39:620A. Abstract.
Seelig CB. Affecting residents’ literature reading attitudes, behaviors, and knowledge through a journal club intervention. J Gen Intern Med. 1991;6:330–4.
Linzer M, Brown JT, Frazier LM, DeLong ER, Siegel WC. Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills: a randomized controlled trial. JAMA. 1988;260:2537–41.
Woods JR, Winkel CE. Journal club format emphasizing techniques of critical reading. J Med Educ. 1982;57:799–801.
Kitchens JM, Pfeifer MP. Teaching residents to read the medical literature: a controlled trial of curriculum in critical appraisal/clinical epidemiology. J Gen Intern Med. 1989;4:384–7.
Gehlbach SH, Bobula JA, Dickinson JC. Teaching residents to read the medical literature. J Med Educ. 1980;55:362–5.
Inui TS. Critical reading seminars for medical residents: report of a teaching technique. Med Care. 1981;29:122–4.
Knowles M. The Adult Learner: A Neglected Species. Houston, Tex: Gulf Publishing Co.; 1984.
Barrows HS. Problem-based, self-directed learning, JAMA. 1983; 250:3077–80.
Neame RLB, Powis DA. Toward independent learning: curricular design for assisting students to learn how to learn. J Med Educ. 1981;56:886–93.
Richardson WS, Wilson MC, Nishikawa J, Hayward RSA. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123:A12–13. Editorial.
McKibbon KA, Walker-Dilks CJ. Beyond ACP Journal Club: how to harness MEDLINE for therapy problems. ACP J Club. 1994; 121(1):A10–12. Editorial.
McKibbon KA, Walker-Dilks CJ. Beyond ACP Journal Club: how to harness MEDLINE for diagnostic problems. ACP J Club. 1994; 121(2):A10–12. Editorial.
Walker-Dilks CJ, McKibbon KA, Haynes RB. Beyond ACP Journal Club: how to harness MEDLINE for etiology problems. ACP J Club. 1994;121(3):A10–11. Editorial.
McKibbon KA, Walker-Dilks C, Haynes RB, Wilczynski N. Beyond ACP Journal Club: how to harness MEDLINE for prognosis problems. ACP J Club. 1995;123:A12–14. Editorial.
Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature. II: how to use an article about therapy or prevention. A: are the results of the study valid? JAMA. 1993;270:2598–601.
Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Medicine Working Group. Users’ guide to the medical literature, II: how to use an article about therapy or prevention, B: what are the results and will they help me in caring for my patients? JAMA. 1994;271:59–63.
Laupacis A, Wells G, Richardson WS, Tugwell P, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature, V: how to use an article about prognosis. JAMA. 1994;272: 234–7.
Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature, IV: how to use an article about harm. JAMA. 1994;271:1615–9.
Jaeschke R, Guyatt G, Sackett DL, for the Evidence-Based Medicine Working Group. Users’ guide to the medical literature. III: how to use an article about a diagnostic test, A: are the results of the study valid? JAMA. 1994;271:389–91.
Jaeschke R, Guyatt G, Sackett DL, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature, III: how to use an article about a diagnostic test, B: what are the results and will they help me in caring for my patients? JAMA. 1994;271:703–7.
Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature, VII: how to use a clinical decision analysis, A: are the results of the study valid? JAMA. 1995;273:1292–5.
Richardson WS, Detsky AS, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature, VII: how to use a clinical decision analysis, B: what are the results and will they help me in caring for my patients? JAMA. 1995;273:1610–3.
Oxman AD, Cook DJ, Guyatt GH, for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature, VI: how to use an overview. JAMA. 1994;272:1367–71.
Stern DT, Linzer M, O’Sullivan PS, Weld L. Evaluating medical residents’ literature-appraisal skills. Acad Med. 1995;70:152–4.
Sauve S, Lee HN, Meade MO, et al. The critically appraised topic: a practical approach to learning critical appraisal. Annals Royal College Physicians and Surgeons of Canada. 1995;28:396–8.
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Green, M.L., Ellis, P.J. Impact of an evidence-based medicine curriculum based on adult learning theory. J GEN INTERN MED 12, 742–750 (1997). https://doi.org/10.1046/j.1525-1497.1997.07159.x
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DOI: https://doi.org/10.1046/j.1525-1497.1997.07159.x