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Impact of an evidence-based medicine curriculum based on adult learning theory

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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

  1. Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA. 1992;268:2420–5.

    Article  Google Scholar 

  2. Sackett DL, Rosenberg WMC. The need for evidence-based medicine. J R Soc Med. 1995;88:620–4.

    PubMed  CAS  Google Scholar 

  3. Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient medicine is evidence based. Lancet. 1995;346:407–10.

    Article  PubMed  CAS  Google Scholar 

  4. 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.

    Article  PubMed  CAS  Google Scholar 

  5. 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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  7. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985;103:596–9.

    PubMed  CAS  Google Scholar 

  8. Osiobe SA. Use of information resources by health professionals: a review of the literature. Soc Sci Med. 1985;21:965–73.

    Article  PubMed  CAS  Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. Weiss ST, Samet JM. An assessment of physician knowledge of epidemiology and biostatistics. J Med Educ. 1980;55:692–7.

    PubMed  CAS  Google Scholar 

  11. Berwick DM, Fineberg HV, Weinstein MC. When doctors meet numbers. Am J Med. 1981;71:991–8.

    Article  PubMed  CAS  Google Scholar 

  12. Barondess JA. The future physician: realistic expectations and curricular needs. J Med Educ. 1981;56:381–9.

    PubMed  CAS  Google Scholar 

  13. Rafuse J. Evidence-based medicine means MDs must develop new skills, attitudes, CMA conference told. Can Med Assoc J. 1994; 150:1479–80.

    CAS  Google Scholar 

  14. 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.

    Google Scholar 

  15. 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.

  16. Cullinan TR. Teaching concepts in epidemiology. J Epidemiol Community Health. 1980;34:201–3.

    PubMed  CAS  Google Scholar 

  17. 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.

    PubMed  CAS  Google Scholar 

  18. Knapp RG, Miller MC. Clinical relevance: an issue in biostatistical training of medical students. Med Educ. 1987;21:32–7.

    Article  PubMed  CAS  Google Scholar 

  19. Radack KL, Valanis B. Teaching critical appraisal and application of medical literature to clinical problem solving. J Med Educ. 1986;61:329–31.

    PubMed  CAS  Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. Linzer M, Mercando A, Hupart KH. Role of a medical journal club in residency training. J Med Educ. 1986;61:471–3.

    PubMed  CAS  Google Scholar 

  23. Sidorov J. How are internal medicine residency journal clubs organized and what makes them successful? Arch Intern Med. 1995;155:1193–7.

    Article  PubMed  CAS  Google Scholar 

  24. 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.

    PubMed  CAS  Google Scholar 

  25. 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.

    Google Scholar 

  26. Seelig CB. Affecting residents’ literature reading attitudes, behaviors, and knowledge through a journal club intervention. J Gen Intern Med. 1991;6:330–4.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

    Article  PubMed  CAS  Google Scholar 

  28. Woods JR, Winkel CE. Journal club format emphasizing techniques of critical reading. J Med Educ. 1982;57:799–801.

    PubMed  Google Scholar 

  29. 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.

    Article  PubMed  CAS  Google Scholar 

  30. Gehlbach SH, Bobula JA, Dickinson JC. Teaching residents to read the medical literature. J Med Educ. 1980;55:362–5.

    PubMed  CAS  Google Scholar 

  31. Inui TS. Critical reading seminars for medical residents: report of a teaching technique. Med Care. 1981;29:122–4.

    Article  Google Scholar 

  32. Knowles M. The Adult Learner: A Neglected Species. Houston, Tex: Gulf Publishing Co.; 1984.

    Google Scholar 

  33. Barrows HS. Problem-based, self-directed learning, JAMA. 1983; 250:3077–80.

    Article  PubMed  CAS  Google Scholar 

  34. Neame RLB, Powis DA. Toward independent learning: curricular design for assisting students to learn how to learn. J Med Educ. 1981;56:886–93.

    PubMed  CAS  Google Scholar 

  35. 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.

    PubMed  CAS  Google Scholar 

  36. 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.

    Google Scholar 

  37. 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.

    Google Scholar 

  38. 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.

    CAS  Google Scholar 

  39. 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.

    PubMed  CAS  Google Scholar 

  40. 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.

    Article  PubMed  CAS  Google Scholar 

  41. 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.

    Article  PubMed  CAS  Google Scholar 

  42. 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.

    Article  PubMed  CAS  Google Scholar 

  43. 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.

    Article  PubMed  CAS  Google Scholar 

  44. 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.

    Article  PubMed  CAS  Google Scholar 

  45. 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.

    Article  PubMed  CAS  Google Scholar 

  46. 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.

    Article  PubMed  CAS  Google Scholar 

  47. 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.

    Article  PubMed  CAS  Google Scholar 

  48. 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.

    Article  PubMed  CAS  Google Scholar 

  49. Stern DT, Linzer M, O’Sullivan PS, Weld L. Evaluating medical residents’ literature-appraisal skills. Acad Med. 1995;70:152–4.

    Article  PubMed  CAS  Google Scholar 

  50. 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.

    Google Scholar 

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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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