Evidence-based medicine training in residency: a survey of urology programme directors

Effectiveness of Journal Club Presentation as a Learning Modality in the Endocrinology and Endocrine Surgery Module in an Integrative Undergraduate Medical Curriculum

Introduction

The journal club is widely used in most postgraduate programs of medical institutes; however, the use of journal clubs in undergraduate medical programs is nearly absent or very rare.

Aim

The aim of this work is to document the insertion of the journal club as a method for learning in the undergraduate starting with the endocrinology/endocrine surgery module to be fully implemented in all modules of the MBBS of FMBU. In addition, the study aimed to outline the steps of designing a journal club by following specific procedures and Identification of students' and faculty satisfaction through 5-years implementation of the journal club.

Material and Methods

A total of 453 students representing the five consecutive batches of medical students from 2019 to 2023 who studied the endocrinology/endocrine surgery module were entered into the study. Following guidelines for implementation of the journal clubs that were adopted by the quality and accreditation committee, the faculty select the types of papers from the articles chosen by students. The papers discussed were case reports, original research, and review articles. The students were asked to formulate critical appraisal topics, PICO, for each paper. A 20-question test was applied to all participants. The students' attendance, scores, and students/faculty satisfaction were estimated.

Results

A total of 50 papers were discussed in the 5-year journal club 15 case reports (30%), 26 original research (52%), and 9 review articles (18%). The student's attendance ranged from 72.53±3.74 to 98.07±3.15. The students and faculty's satisfaction were 3.52 and 3.82 respectively. The mean Students' score in A 20-question test in a 5-year journal club was 76.93 ± 9.78 and the lowest score was in the 2nd batch (online batch).

Conclusion

The insertion of a well-structured journal club in the undergraduate medical program is necessary to improve the knowledge including knowledge among students. In addition, journal clubs inspire students to be lifelong learners.

Evidence-based Medicine: Perceptions, Attitudes, and Skills Among European Urology Residents

Background

Evidence-based medicine (EBM) was introduced as a concept in the early 1990s as an integration of the best available evidence with clinical expertise and patient values.

Objective

To evaluate the current status of EBM training and EBM perception, attitudes, and self-perceived skills among European urology residents.

Design setting and participants

Our online open survey comprised 28 multiple-choice items, including ten questions with responses on a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. The survey was distributed via the mailing lists and social media accounts of the European Society of Residents in Urology, German Society of Residents in Urology, French Society of Urologists in Training, Spanish Urology Residents Working Group, Italian Society of Residents in Urology, and the Urology Social Media Working Group in two rounds (May-July 2019 and July 2020). We excluded responses from non-European countries.

Outcome measurements and statistical analysis

The online open survey comprised 28 multiple-choice items. These included ten questions with answers on a five-point Likert scale with response items ranging from strongly disagree (score of 1) to strongly agree (score of 5).

Results and limitations

We received 210 responses, of which 181 from 23 European countries were eligible. Approximately three-quarters (73.7%) of the respondents were male, with a mean age of 31 yr. Only 28.2% reported EBM training as part of their urology curriculum and 19.3% felt that the training they received was sufficient to guide their daily practice. An overwhelming majority (91.5%) stated that they would be interested in more formalized EBM training or additional training. There was a strong level of agreement (median score 5, interquartile range 4-5) that EBM is important for daily medical and surgical practice and that it improves patient care. Overall, the mean self-perceived understanding of basic EBM concepts was good. Limitations include concerns about generalizability given its internet-based format, the inability to calculate a response rate, poor representation from some European regions, and limited sample size.

Conclusions

Our survey suggests that European urology residents receive a limited amount of EBM training despite considerable appreciation, interest, and self-perceived deficits for more advanced concepts. Formal integration of EBM teaching in all European residency programs should be considered.

Patient summary

We performed an online survey of urology residents in Europe. We found that residents have positive perceptions of and attitudes to evidence-based medicine but most programs lack formal training in this area.

"Landmark" Articles in Female Pelvic Medicine and Reconstructive Surgery: Do We Read What We Cite?

OBJECTIVE

The aim of the study was to describe the provision of a "landmark" article reading list to trainees by their Female Pelvic Medicine & Reconstructive Surgery (FPMRS) fellowship programs.

METHODS

In this cross-sectional study, a web-based survey was sent to program coordinators of accredited FPMRS programs. Available reading lists were collected, and a master list compiled. Nonparametric tests were used to investigate the association between the number of faculty members and presence of a reading list.

RESULTS

We received a response from 46 (92%) of the 50 Accreditation Council for Graduate Medical Education programs contacted. Half the programs (23/46, 50%) reported that they do not offer a recommended reading list, 5 programs were unsure and over more than 60% with a list (12/18, 67%) shared their list with the investigators. Programs had between 2 and 14 core faculty members with a median (interquartile range) of 4 (3-6). Programs with a reading list had significantly fewer faculty members (3.5, 3-5 vs 5, 3-6, P = 0.03). There were 323 unique articles across the 12 lists, with a median of 25 articles per list. Thirty-four articles were on 4 or more lists; 9 of these (9/34, 26%) have previously been identified as citation classics.

CONCLUSIONS

At least 50% of the Accreditation Council for Graduate Medical Education accredited programs do not provide their fellows with a recommended reading list, and fewer core faculty members are associated with the presence of such a list. Although some commonalities are found between reading lists, a universal reading list of "landmark" articles could improve the consistency of FPMRS fellowship education.

Evidence-Based Medicine Curriculum Improves Pediatric Emergency Fellows' Scores on In-Training Examinations

OBJECTIVES

The aim of this study was to determine if implementation of our evidence-based medicine (EBM) curriculum had an effect on pediatric emergency medicine fellows' scores on the relevant section of the in-training examination (ITE).

METHODS

We obtained deidentified subscores for 22 fellows over 6 academic years for the Core Knowledge in Scholarly Activities (SA) and, as a balance measure, Emergencies Treated Medically sections. We divided the subscores into the following 3 instruction periods: "baseline" for academic years before our current EBM curriculum, "transition" for academic years with use of a research method curriculum with some overlapping EBM content, and "EBM" for academic years with our current EBM curriculum. We analyzed data using the Kruskal-Wallis test, the Mann-Whitney U test, and multivariate mixed-effects linear models.

RESULTS

The SA subscore median was higher during the EBM period in comparison with the baseline and transition periods. In contrast, the Emergencies Treated Medically subscore median was similar across instruction periods. Multivariate modeling demonstrated that our EBM curriculum had the following independent effects on the fellows' SA subscore: (1) in comparison with the transition period, the fellows' SA subscore was 21 percentage points higher (P = 0.005); and (2) in comparison to the baseline period, the fellows' SA subscore was 28 percentage points higher during the EBM curriculum instruction period (P < 0.001).

CONCLUSIONS

Our EBM curriculum was associated with significantly higher scores on the SA section of the ITE. Pediatric emergency medicine educators could consider using fellows' scores on this section of the ITE to assess the effect of their EBM curricula.

Urology training in the developing world: The trainers' perspective

Context

Despite producing some of the leading urologists in the world, urological training in the developing world is marred by inconsistency, and a lack of structure and focus on evidence-based practice. In this review we address these issues from the trainers’ perspective.

Introduction

Teaching the art and science of urological practice is a demanding task. It not only involves helping the resident to develop the depth of cognitive knowledge, but also to have an appropriate surgical judgement, and an ability to act quickly but thoughtfully and, when necessary, decisively.

Discussion

The surgeon must have compassion, communication skills, be perceptive and dedicated. Most importantly, however, he or she should have the ability to cut and suture. Not all of these can be inculcated in the training programme, even with the best of efforts. The selection of an appropriate candidate therefore becomes an issue of pivotal importance. The changing focus of urological training incorporates research and evidence-based practice as essential components. It is particularly important in the developing world, as there is a dearth of standardised practice models across the healthcare system. Encouraging female residents can be done by improving and tailoring the working conditions. The ‘brain drain’ is a major problem in the developing world, and bureaucracy and government need to take appropriate measures to provide high-quality healthcare facilities with room for professional growth.

Conclusions

The future of urology will depend on improved education and training, leading to high-quality urological care, and to developing a service that is patient focused.

Translation through argumentation in medical research and physician-citizenship

While many "benchtop-to-bedside" research pathways have been developed in "Type I" translational medicine, vehicles to facilitate "Type II" and "Type III" translation that convert scientific data into clinical and community interventions designed to improve the health of human populations remain elusive. Further, while a high percentage of physicians endorse the principle of citizen leadership, many have difficulty practicing it. This discrepancy has been attributed, in part, to lack of training and preparation for public advocacy, time limitation, and institutional resistance. As translational medicine and physician-citizenship implicate social, political, economic and cultural factors, both enterprises require "integrative" research strategies that blend insights from multiple fields of study, as well as rhetorical acumen in adapting messages to reach multiple audiences. This article considers how argumentation theory's epistemological flexibility, audience attentiveness, and heuristic qualities, combined with concepts from classical rhetoric, such as rhetorical invention, the synecdoche, and ethos, yield tools to facilitate translational medicine and enable physician-citizenship.

How to teach evidence-based medicine to urologists

The goal of this article is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for urology residents and continuing education of urologists to reduce the gap between research and clinical practice. Urology departments should build capacity for residents to shape the future of quality and safety in healthcare through translating evidence into practice. Cutting edge approaches require knowing how to teach Evidence-based urology, to make Bio-statistics easy to understanding and how to lead improvement at every level. The authors shared their experience about ‘what works’ in a surgical department to building an Evidence-based environment and high quality of cares.

Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature

OBJECTIVE

Systematic reviews were performed to assess methods of teaching the evidence-based medicine (EBM) process and determine which format or what components of journal club appear to be most effective in teaching critical appraisal skills to surgical residents and have the highest user satisfaction.

DESIGN

MEDLINE, Embase, Web of Science, AMED, PsychINFO, PubMed, Cochrane Library, and Google scholar were searched to identify relevant articles. To be included, studies had to provide details about the format of their EBM curriculum or journal club and report on the effectiveness or participant satisfaction. Potentially relevant articles were independently reviewed by 2 authors and data were extracted on separate data forms.

RESULTS

Seven studies met the inclusion criteria for assessment of teaching EBM and 8 studies (including 3 in the EBM systematic review) met criteria for assessment of journal club format. Overall, study quality was poor. Only 2 studies were randomized controlled trials. Five were before-after studies, which showed significant improvement in critical appraisal skills or statistical knowledge following an EBM course or journal club. The 2 randomized controlled trials (RCTs) compared teaching EBM or critical appraisal skills in lecture format or journal club to online learning. There was no significant difference in mean scores in 1 study whereas the other reported significantly better scores in the journal club format. Four studies reported high participant satisfaction with the EBM course or journal club format.

CONCLUSIONS

There is some evidence that courses with or without the addition of journal clubs lead to improved knowledge of the EBM process although the impact on patient care is unknown. Journal clubs seem to be the preferred way of teaching critical appraisal skills but while some components of journal clubs are favored by participants, it remains unclear which elements are most important for resident learning.

The practice of evidence-based medicine (EBM) in gastroenterology: discrepancies between EBM familiarity and EBM competency

INTRODUCTION

Evidence-based medicine (EBM) has become increasingly important in the practice of gastroenterology and endoscopy, and the training of future gastroenterology physicians. The objectives were to assess the attitudes/opinions of gastroenterology specialists towards EBM, and evaluate possible gaps in education for certain EBM-related concepts.

METHODS

An internet-based survey was emailed to 4073 gastroenterology specialists. The main outcome measurements were physicians' endorsement of EBM, impact of EBM on clinical practice, utilization of EBM-specific resources, self-assessed understanding of EBM concepts (EBM familiarity score), and actual knowledge of EBM concepts (EBM competency score).

RESULTS

A total of 337 gastroenterology specialists participated. On a sale of 1-10, there was widespread agreement that EBM improves patient care (median score = 9, interquartile range (IQR) = 7-10), and physicians should be familiar with techniques for critical appraisal of studies (median = 9, IQR = 8-10). Most (64.0%) utilized the EBM-related resource UpToDate™ regularly, as opposed to PubMed™ (47.1%) or Clinical Evidence™ (5.4%). The mean EBM familiarity score was 3.4 ± 0.6 on a scale of 1-4. Out of a maximum 49 points, the mean EBM competency score was 35 ± 4.9. There was poor concordance among EBM familiarity and competency scores (r = 0.161; p = 0.005). Academic practice (p < 0.001), research/teaching (p < 0.001), advanced degree (p = 0.012), and recent EBM training (p = 0.001) were all associated with improved EBM competency.

CONCLUSION

The attitudes and opinions of EBM are extremely favorable among gastroenterology physicians. Although gastroenterology physicians report familiarity with most EBM-related concepts, there is poor correlation with their actual knowledge of EBM. Further educational initiatives should be undertaken to address methods in which EBM skills are reinforced among all gastroenterology practitioners.

Realistic anatomical prostate models for surgical skills workshops using ballistic gelatin for nerve-sparing radical prostatectomy and fruit for simple prostatectomy

Purpose

Understanding of prostate anatomy has evolved as techniques have been refined and improved for radical prostatectomy (RP), particularly regarding the importance of the neurovascular bundles for erectile function. The objectives of this study were to develop inexpensive and simple but anatomically accurate prostate models not involving human or animal elements to teach the terminology and practical aspects of nerve-sparing RP and simple prostatectomy (SP).

Materials and Methods

The RP model used a Foley catheter with ballistics gelatin in the balloon and mesh fabric (neurovascular bundles) and balloons (prostatic fascial layers) on either side for the practice of inter- and intrafascial techniques. The SP model required only a ripe clementine, for which the skin represented compressed normal prostate, the pulp represented benign tissue, and the pith mimicked fibrous adhesions. A modification with a balloon through the fruit center acted as a "urethra."

Results

Both models were easily created and successfully represented the principles of anatomical nerve-sparing RP and SP. Both models were tested in workshops by urologists and residents of differing levels with positive feedback.

Conclusions

Low-fidelity models for prostate anatomy demonstration and surgical practice are feasible. They are inexpensive and simple to construct. Importantly, these models can be used for education on the practical aspects of nerve-sparing RP and SP. The models will require further validation as educational and competency tools, but as we move to an era in which human donors and animal experiments become less ethical and more difficult to complete, so too will low-fidelity models become more attractive.

Education and training in evidence-based urology

OBJECTIVES

Urologists believe evidence-based clinical practice improves patient care. Competence in critical appraisal skills is necessary to successfully implement evidence-based practice. However, practicing urologists, urology program training directors, and residents have identified the need for urology-specific resources to promote competence in evidence-based practice. The objective of this review is to identify urology-specific educational resources for critical appraisal skills.

METHODS

The PubMed(®) database was searched using the terms "evidence-based urology", "training" and "medical education." Results were limited to systematic reviews. Reference lists for manuscripts were manually searched to identify additional relevant publications. Additional educational resources and training opportunities were identified via direct communication with authors.

RESULTS

New urology-specific educational resources are being developed to support evidence-based clinical practice. Resources exist in the medical literature, including the User's Guide to the Urological Literature series and the Evidence-Based Urology in Practice series. Electronic resources include the Evidence Based Reviews in Urology program sponsored by the American Urological Association. Finally, workshops exist for live training to develop expertise in teaching EBM skills to others.

CONCLUSION

Educational support for the nascent evidence-based clinical practice movement in urology is growing. Journals provide the majority of urology-specific educational material for evidence-based medicine training. Additional online and live training opportunities should be developed to encourage competence and leadership in evidence-based urology.

The role of randomized controlled trials in evidence-based urology

PURPOSE

To review the current and future role of randomized controlled trials (RCTs) in urology.

METHODS

A review of the urological literature was performed to assess the current role of RCTs in urology. These findings were put in context of current practice, and methodologic limitations of observational study design were discussed.

RESULTS

Several RCTs have improved treatment of urology patients. However, overall, few studies in the urologic literature convey high-level evidence. RCTs represent the only study design that can assess causality, thus are the only means to significantly advance knowledge about therapy and improve patient care. Increased incidence and improved quality of RCTs may be achieved through education, community outreach, and better access to research infrastructure.

CONCLUSIONS

RCTs have significantly improved urologic practice. RCTs are superior to observational studies because of decreased risk of bias and confounding. To further advance clinical practice, clinical trials must play a predominant role and should be embraced by the urology community.