From west to east; experience with adapting a curriculum in evidence-based medicine

Development and evaluation of an evidence-based medicine module in the undergraduate medical curriculum

BACKGROUND

Evidence-based medicine (EBM) is a core competence in both undergraduate and postgraduate medical curricula. However, its integration into curricula varies widely. Our study will help medical colleges develop, implement and evaluate their EBM courses. We assessed the effectiveness of workshops in improving critical appraisal skills among medical students.

METHODS

A before-and-after study design without a control group was used. A 5-week short EBM module including lectures, workshops, and online search sessions was conducted with 52 fourth-year medical students during their primary healthcare course at the College of Medicine, Princess Nourah bint Abdulrahman University. Statistical analysis was performed using SPSS statistical software (version 20, SPSS Inc., Chicago, US). Parametric tests as well as Student's paired t-test for pre- and post-test comparisons were used.

RESULTS

Forty-nine (49) participants completed the pre- and post-training Fresno tests, and 44.9% of the participants had a GPA of 4.0 or higher. The mean Fresno test score increased from 45.63 (SD 21.89) on the pre-test to 64.49 (SD 33.31) on the post-test, with significant improvements in the following items: search strategies, relevance, internal validity, magnitude and significance of results, statistical values of diagnosis studies (sensitivity, specificity, and LR), statistical values of therapy studies (ARR, RRR, and NNT), and best study design for diagnosis and prognosis (P < 0.05).

CONCLUSION

This study supports that a short course in EBM that is incorporated into the undergraduate curriculum, especially in the clinical years, might be effective in improving medical students' knowledge and skills in EBM. However, prospective studies are necessary to assess the long-term impact of these interventions and ultimately their effectiveness for clinical decision making.

Evaluation of the role of near-peer teaching in critical appraisal skills learning: a randomized crossover trial

OBJECTIVES

The study sought to evaluate near-peer tutors' teaching of critical appraisal skills to medical students as an aspect of Evidence-based Medicine.

METHODS

In a randomized crossover trial, 241 students completing a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module in the Faculty of Medicine Universitas Indonesia (FMUI) were randomly assigned to intervention or control groups. During tutorial sessions, intervention group participants were assigned to near-peer tutors, who were newly graduated doctors, and those in the control groups were assigned to staff tutors. After two tutorial sessions, intervention and control groups exchanged tutors for the next two sessions. Outcomes were measured using written knowledge and skills multiple choice questions (MCQ) test, the Evidence-based Practice Confidence Scale (EPIC) and a student attitude questionnaire, along with student evaluation of tutors to evaluate the process.

RESULTS

On completion of the module, the written test scores of intervention group students were similar to those of the control group (t₍₂₃₉₎ = 1.553, p=0.122), as well as overall Evidence-based Practice Confidence Scale scores (F_(2/170) = 0.179, p = 0.673) and attitude scores (t₍₂₁₉₎ =-0.676, p = 0.085). In the tutor evaluations, the students rated their near-peer tutored sessions as better than those tutored by staff in most respects.

CONCLUSIONS

Near-peer tutors were as effective as and more readily accepted than staff tutors in teaching critical appraisal skills. These findings support the broader implementation of peer-teaching in other areas of medical education.

The effect of an evidence-based medicine course on medical student critical thinking

OBJECTIVE

Evidence-based medicine (EBM) was designed to foster student critical thinking (CT) while conveying knowledge to them. Chinese medical schools have adopted EBM to a varying degree but studies to examine its intended effect are few. This study evaluates the effect of an EBM course on Chinese medical student CT.

METHODS

A total of 158 medical students at a Chinese medical school took a seven-category Chinese version of the critical thinking disposition inventory (CTDI-CV) before and after taking an EBM course. Two-tailed, paired t-test measured the course effect.

RESULTS

Undergraduate (BS) students showed a significant mean difference (MD) in confidence (MD = 1.43, P = 0.025), inquisitiveness (MD = 1.23, P = 0.041), and overall score (MD = 3.45, P = 0.000). Graduate (MS) students showed a more significant mean difference in confidence (MD = 2.72, P = 0.006). Moreover, BS student course grade was correlated with truth-seeking (r = 0.214, P = 0.029) and open-mindedness (r = 0.246, P = 0.012) while that of MS student was correlated with systematicity (r = 0.295, P = 0.031) and overall score (r = 0.290, P = 0.033).

CONCLUSIONS

The results indicate some positive effect of an EBM course on student CT due to embedded CT elements in delivering the content. The discrepancy between a higher admission test score and weaker confidence shown by MS students reveals a drawback of the test centered Chinese education system.

Evaluation of best practices in the design of online evidence-based practice instructional modules

OBJECTIVES

The research determined to what extent best practices are being followed by freely available online modules aimed at teaching critical thinking and evidence-based practices (EBPs) in health sciences fields.

METHODS

In phase I, an evaluation rubric was created after reviewing the literature. Individual rubric questions were assigned point values and grouped into sections, and the sections weighted. Phase II involved searching Internet platforms to locate online EBP modules, which were screened to determine if they met predetermined criteria for inclusion. Phase III comprised a first evaluation, in which two authors assessed each module, followed by a second evaluation of the top-scoring modules by five representatives from different health sciences units.

RESULTS

The rubric's 28 questions were categorized into 4 sections: content, design, interactivity, and usability. After retrieving 170 online modules and closely screening 91, 42 were in the first evaluation and 8 modules were in the second evaluation. Modules in the first evaluation earned, on average, 59% of available points; modules in the second earned an average of 68%. Both evaluations had a moderate level of inter-rater reliability.

CONCLUSIONS

The rubric was effective and reliable in evaluating the modules. Most modules followed best practices for content and usability but not for design and interactivity.

IMPLICATIONS

By systematically collecting and evaluating instructional modules, the authors found many potentially useful elements for module creation. Also, by reviewing the limitations of the evaluated modules, the authors were able to anticipate and plan ways to overcome potential issues in module design.

Moving from knowledge to practice: is it time to move from teaching evidence-based medicine (EBM) to knowledge translation competency?

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Perspectives …

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Direct short-term effects of EBP teaching: change in knowledge, not in attitude; a cross-cultural comparison among students from European and Asian medical schools

INTRODUCTION

We report about the direct short-term effects of a Clinical Epidemiology and Evidence-based Medicine (CE-EBM) module on the knowledge, attitude, and behavior of students in the University Medical Center Utrecht (UMCU), Universitas Indonesia (UI), and University of Malaya (UM).

METHODS

We used an adapted version of a 26-item validated questionnaire, including four subscales: knowledge, attitude, behavior, and future use of evidence-based practice (EBP). The four components were compared among the students in the three medical schools before the module using one-way ANOVA. At the end of the module, we measured only knowledge and attitudes. We computed Cronbach's α to assess the reliability of the responses in our population. To assess the change in knowledge and attitudes, we used the paired t-test in the comparison of scores before and after the module.

RESULTS

In total, 526 students (224 UI, 202 UM, and 100 UMCU) completed the questionnaires. In the three medical schools, Cronbach's α for the pre-module total score and the four subscale scores always exceeded 0.62. UMCU students achieved the highest pre-module scores in all subscales compared to UI and UM with the comparison of average (SD) score as the following: knowledge 5.04 (0.4) vs. 4.73 (0.69) and 4.24 (0.74), p<0.001; attitude 4.52 (0.64) vs. 3.85 (0.68) and 3.55 (0.63), p<0.001; behavior 2.62 (0.55) vs. 2.35 (0.71) and 2.39 (0.92), p=0.016; and future use of EBP 4.32 (0.59) vs. 4.08 (0.62) and 3.7 (0.71), p<0.01. The CE-EBM module increased the knowledge of the UMCU (from average 5.04±0.4 to 5.35±0.51; p<0.001) and UM students (from average 4.24±0.74 to 4.53±0.72; p<0.001) but not UI. The post-module scores for attitude did not change in the three medical schools.

CONCLUSION

EBP teaching had direct short-term effects on knowledge, not on attitude. Differences in pre-module scores are most likely related to differences in the system and infrastructure of both medical schools and their curriculum.