Short course in evidence-based medicine improves knowledge and skills of undergraduate medical students: a before-and-after study

Formal evidence-based medicine instruction in Turkish undergraduate medical education: an initial evaluation

BACKGROUND

Global and national undergraduate medical education accreditation organizations recommend the inclusion of Evidence-Based Medicine (EBM) instructions into the medical schools' curricula. Accordingly, some Turkish medical schools have individually developed and implemented EBM training programs, but there is no data of current programs' effectiveness and students' learning achievements due to the lack of a validated Turkish language EBM assessment tool. This study evaluates the effect of a newly introduced formal EBM instruction to the curriculum on students' knowledge and skills by using the recently published Turkish adaptation of the Fresno Test.

METHODS

The study is an experimental investigation using pre- and post-test evaluations. A five-week EBM course was developed according to Kern's six-step curriculum development approach. A total of 78 students from the third (n = 30), fourth (n = 19) and fifth (n = 29) year of medical school voluntarily consented and were enrolled into the course. Overall, the Cerrahpaşa Medical Faculty had a total of 555, 461, and 400 students enrolled in the third, fourth, and fifth year, respectively. The program has been evaluated based on students' learning achievements and survey responses.

RESULTS

The students' mean pre-test Fresno Test score improved from 49.9 ± 18.2 to 118.9 ± 26.3 post-training. The Cohen's effect size was 3.04 (95% CI, 2.6-3.5). The overall students' satisfaction score was 8.66 ± 1.09 on a 1 to 10 scale.

CONCLUSIONS

The program was effective in improving students' knowledge and skills on EBM. We propose to offer the program as an elective course during the third year of the medical school curriculum based on all data obtained during the program evaluation.

Critical appraisal of journal article by psychiatry PG residents using a new module: Impact analysis

BACKGROUND

A gap exists from evidence-based medicine (EBM) to clinical practice and there is a felt need to bridge this. Critical appraisal of scientific articles during Journal club by postgraduate (PG) residents will help them to understand and apply the scientific evidence into best clinical practice. Hence, a new module of critical appraisal of journal articles was used for Psychiatry Residents in a Medical College and its impact was assessed.

MATERIALS AND METHODS

Nine psychiatry PG residents from three academic batches participated in the study after informed consent and Institutional ethical committee clearance. They were trained in the Colorado Psychiatry EBM Examination Test module. Subsequently, three consecutive journal article presentations of them were assessed under seven Subtests of the module.

RESULTS

There was gradual increase in the assessment scores of all PG residents with each journal article presentation. They also expressed satisfaction of the assessment method and felt confident of applying the principles of critical appraisal in their clinical practice in future.

CONCLUSION

This study evaluated the impact of a new module of critical appraisal of journal article by psychiatry PG residents. It was found to be acceptable by residents and improved their competency to apply literature-based EBM into their clinical practice. It is recommended for further multicentric evaluation on a larger sample.

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.

Determining effectiveness of EBM education in otolaryngology residents using modified fresno test

OBJECTIVE

To determine the effectiveness of education in evidence-based medicine (EBM) on the knowledge, competency, and skills of otolaryngology residents of Tehran University of Medical Sciences (TUMS) at Amir-Alam and Imam Khomeini Hospitals.

METHODS

In a quasi-experimental (before-and-after) study, all ear, nose, and throat residents of TUMS (n = 41) entered the study. The residents underwent the modified Fresno test. Then, two EBM workshops with a similar content were held on 2 separate days in each hospital, with each session lasting 6 hours. The learned material was practiced in weekly journal clubs. Six months after the workshop, the modified Fresno test was applied again, and the results were analyzed.

RESULTS

A significant improvement in the modified Fresno test score was observed. The mean score of the modified Fresno test was 57.43 ± 22.07 before the workshop and 79.26 ± 22.48 after the workshop (P < 0.001).

CONCLUSION

The results of the study show that EBM education and practice of the learned materials in journal clubs can improve the knowledge and skills of residents. Further research with larger samples is needed to improve the precision of our findings and to increase confidence in the results.

LEVEL OF EVIDENCE

2 Laryngoscope, 129:2291-2294, 2019.

How to choose an evidence-based medicine knowledge test for medical students? Comparison of three knowledge measures

BACKGROUND

There are a few studies of alignment between different knowledge-indices for evidence-based medicine (EBM). The aim of this study was to investigate whether the type of test used to assess knowledge of EBM affects the estimation of this knowledge in medical students.

METHODS

Medical students enrolled in 1-week EBM course were tested with the Fresno, Berlin, and ACE tests at the beginning and the end of the course. We evaluated the ability of these tests to detect a change in the acquired level of EBM knowledge and compared the estimates of change with those of the Control group that was tested with the ACE and Berlin tests before and after an unrelated non-EBM course. The distributions of test scores and average item difficulty indices were compared among the tests and the groups.

RESULTS

Test scores improved on all three tests when compared with their pre-test results and the control. Students had on average a "good" performance on the ACE test, "sufficient" performance on the Berlin test, and "insufficient" performance or have "not passed" on the Fresno test. The post-test improvements in performance on the Fresno test (median 31% increase in percent scores, 95% confidence interval (CI) 25-42%) outperformed those on the ACE (13, 95% CI 13-20%) and Berlin tests (13, 95% CI 7-20%). Post-test score distributions demonstrated that the ACE test had less potential to discriminate between levels of EBM knowledge than other tests.

CONCLUSION

The use of different EBM tests resulted in different assessment of general EBM knowledge in a sample of graduate medical students, with lowest results on the Fresno and highest on the ACE test. In the light of these findings, EBM knowledge assessment should be based on the course's content and learning objectives.

A year-round evidence-based medicine-learning course organized by medical students at Ehime University

To resolve the problem that evidence‐based medicine (EBM) courses are not sufficiently taught in Japanese medical schools, we organized a year‐round EBM‐learning course. This study was an observational study and was designed to evaluate the participants’ understanding of EBM using an original survey. The survey was given three times. In total, 18 students responded to our survey. Of those 18 students, six students answered both the first and the last surveys, and their mean score increased 1.17 of 4.00 (95% CI: 0.72‐1.65). These results suggest our course improved students’ ability to read clinical articles.

Educational strategies for teaching evidence-based practice to undergraduate health students: systematic review

PURPOSE

The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide.

METHODS

The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM).

RESULTS

Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill.

CONCLUSION

Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.