Medical students' attitudes on and experiences with evidence-based medicine: a qualitative study

Can Research Training be Improved in Health Professional Student Curricula? A Qualitative Descriptive Study of Health Students' Experiences with an Integrated Research Training Platform

INTRODUCTION

Project-based learning is currently the status quo for research training for health professional students; however, it alone is not sufficient for holistic development of research skills. One promising style of intervention that can complement project-based research training is a centralised hub of e-learning resources. Therefore, we explored the perception of health professionals in tertiary education, towards the E-learning hub named 'Health and Medical Sciences Research Modules'. Specifically, we explored (1) the role the Modules can play in supporting students in their research training courses, (2) the perception of the selection of topics and content quality and (3) student engagement with content.

METHODS

Semi-structured interviews were conducted via the online platform Zoom for University of Western Australia 3rd- and 4th-year Dental doctoral students, and 2nd-year Master of Pharmacy students. Interview transcripts were analysed using the framework method, to identify manifest and latent level themes.

RESULTS

Eleven participants completed the interview, including five dentistry and six pharmacy students. The analysis yielded numerous manifest level themes including selection and depth of topics, and four latent level themes: content volume and balance, relevance of content to project, alignment and sequencing, and interactivity.

DISCUSSION

The present study suggests the Modules content and the online platform were well received as a complementary intervention to project-based learning. However, issues such as content oversaturation emerged as topics which can be addressed to improve the learning experience. These topics should be considered when considering further implementation of e-learning hubs to complement project-based learning, across Australia and worldwide.

Integrating evidence-based medicine skills into a medical school curriculum: a quantitative outcomes assessment

OBJECTIVES

This research project aims to determine the potential differential impact of two curricular approaches to teaching evidence-based medicine (EBM) on student performance on an EBM assignment administered during the first year of clerkship. A meaningful result would be any statistically significant difference in scores on the assignment given to measure student performance.

DESIGN

In order to assess and compare student learning under the different curricula, the principal investigator and a team of five faculty members blinded to assignment date and other possibly identifying details used a modified version of the previously validated Fresno rubric to retrospectively grade 3 years' worth of EBM assignments given to students in clerkship rotations 1-3 (n=481) during the Internal Medicine clerkship. Specifically, EBM performance in three separate student cohorts was examined.

SETTING

The study took place at a large Midwestern medical school with nine campuses across the state of Indiana.

PARTICIPANTS

Study participants were 481 students who attended the medical school and completed the Internal Medicine clerkship between 2017 and 2019.

INTERVENTIONS

Prior to the inception of this study, our institution had been teaching EBM within a discrete 2-month time period during medical students' first year. During a large-scale curricular overhaul, the approach to teaching EBM was changed to a more scaffolded, integrated approach with sessions being taught over the course of 2 years. In this study, we assess the differential impact of these two approaches to teaching EBM in the first 2 years of medical school.

MAIN OUTCOME MEASURES

We used clerkship-level EBM assignment grades to determine whether there was a difference in performance between those students who experienced the old versus the new instructional model. Clerkship EBM assignments given to the students used identical questions each year in order to have a valid basis for comparison. Additionally, we analysed average student grades across the school on the EBM portion of step 1.

RESULTS

Four hundred and eighty-one assignments were graded. Mean scores were compared for individual questions and cumulative scores using a one-way Welch Analysis of Variance test. Overall, students performed 0.99 of a point better on the assignment from year 1 (Y1), prior to EBM curriculum integration, to year 3 (Y3), subsequent to EBM integration (p≤0.001). Statistically significant improvement was seen on questions measuring students' ability to formulate a clinical question and critically appraise medical evidence. Additionally, on the United States Medical Licensing Examination (USMLE) step 1, we found that student scores on the EBM portion of the examination improved from Y1 to Y3.

CONCLUSIONS

Results of this study suggest that taking a scaffolded, curriculum-integrated approach to EBM instruction during the preclinical years increases, or at the very least does not lessen, student retention of and ability to apply EBM concepts to patient care. Although it is difficult to fully attribute students' retention and application of EBM concepts to the adoption of a curricular model focused on scaffolding and integration, the results of this study show that there are value-added educational effects to teaching EBM in this new format. Overall, this study provides a foundation for new research and practice seeking to improve EBM instruction.

TRIAL REGISTRATION NUMBER

IRB approval (Protocol number 1907054875) was obtained for this study.

Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study

OBJECTIVES

To determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.

SETTING

This cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.

PARTICIPANTS

The study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.

RESULTS

A total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.

CONCLUSIONS

Although many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

Pain relief during wound care for patients with a deep open wound in an orthopedic trauma department: a best practice implementation project

OBJECTIVES

The aim of this project was to implement best practice in pain relief during wound care for patients with deep open wounds in the orthopedic trauma department of a tertiary teaching hospital in China.

INTRODUCTION

Patients with deep open wounds often suffer from severe pain during wound care. Inadequate pain relief for these patients calls for evidence-based changes to close the gap between current and best practice.

METHODS

The current quality improvement project was carried out over six months using the JBI Practical Application of Clinical Evidence System (JBI PACES). A baseline and two follow-up audits of wound pain management practice were conducted to identify practice gaps and post implementation compliance in pain management in wound care. The sample comprised 20 patients and two dressing nurses. The Getting Research into Practice tool identified barriers to and strategies for improvement in practice. The patients' pain experiences were measured following the implementation of changes.

RESULTS

The baseline audit identified poor compliance with best practice. Following implementation of the recommended changes, some significant improvements in practice were made by the dressing nurses; however, these were inadequately maintained at the second post implementation audit. Patients' pain scores improved following the nurses' practice changes (t = 2.272, P > 0.05).

CONCLUSION

The implementation of best practice in pain relief during wound care for patients with deep open wounds has led to significant improvement in nurses' performance in the orthopedic trauma department. The most challenging barriers involved interdisciplinary collaborations and organizational structure.

Barriers to and Facilitators of Road Traffic Injuries Prevention in Iran; A Qualitative Study

Objective:

To identify the barriers to and facilitators of the prevention of road traffic accidents (RTIs) in Iran.

Methods:

In this qualitative study 42 key stakeholders and experts in the field of traffic injuries in Iran were selected based on purpose and theoretical sampling to reach informational saturation. Their views concerning barriers to and facilitators of the prevention of traffic injuries in Iran were studied using semi-structured interviews. Data were analyzed using Content Analysis method.

Results:

Five themes were identified: structural barriers, organizational barriers and planning, socio-cultural barriers, scientific barriers, and inter-sector barriers and 22 sub-themes were extracted. The lack of lead agency, which was among structural barriers, was selected as the main barrier. The five general facilitators included: sensitization of society and authorities, improving the resources and infrastructure (software and hardware), increasing the attention to safety of vehicles and roads, increasing the information and awareness, and use of expert manpower. The sensitization of society and authorities was selected as the most important facilitator.

Conclusion:

According to the key experts, the barriers of policy changes to prevent the RTIs are more numerous than its facilitators. Therefore, planning and paying more attention to removing these barriers and promoting the facilitators seems necessary to reduce RTIs. Having a lead agency in this regard should be the highest priority.

Preparing for Practice: Strengthening Third-Year Medical Students' Awareness of Point-of-Care Resources

This column describes the development and implementation of a responsive library course designed to train third-year medical students as they begin their clerkships. The course design consisted of a brief face-to-face introduction during third-year orientation and an online course developed in Canvas, an online learning management system. The objective of the course was to not only introduce students to the resources but also to teach them how to effectively use those resources at the point-of-care. Students evaluated the course to assess the overall effectiveness of the instruction. Course development and content, feedback provided by students, as well as suggestions for improvement are discussed.

Evidence- based medicine performance among health care providers in Iranian hospitals: A nationwide survey

Background: Evidence- Based Medicine (EBM) refers to the ability and skill in the use and integration of the best evidence obtained from repeatable bias-free clinical trials with the patients' preferences and conditions. Considering this fact that few large-scale studies have been done in this field in Iran, the present study aimed at comprehensively reviewing the status of EBM performance among health care providers in Iranian hospitals. Methods: This cross-sectional study was conducted during 2014 and 2015. Study participants consisted of 2800 health care providers (physicians, nurses, midwives, and paramedical personnel) in active hospitals in Iran. Data collection tool was a self-made questionnaire. Content validity of the questionnaire was improved by comments of 10 experts. The reliability of the questionnaire was assessed using test-retest method (α= 0.85). Results: The results revealed that only 12.7% and 15.8% of the participants were highly familiar with EBM databases and terminologies, respectively. Most participants believed that EBM-related workshops and practical involvement in EBM-related programs and activities can have a more effect on the improvement of EBM performance. Most participants had a positive view of the EBM. About 47% of the participants reported that their EBM knowledge and skills is high. Among the demographic variables, there were only significant relationships between work experience and attitude, gender and attitudes, and between knowledge and skills (p<0.05). Conclusion: According to the results of the present study, it seems that holding EBM-related workshops and practical participation in EBP-related programs and activities as well as improving facilities such as manpower, equipment, and access can have a significant effect on improving EBM- related activities.

Multiple strategy peer-taught evidence-based medicine course in a poor resource setting

BACKGROUND

Teaching Evidence Based Medicine (EBM) is becoming a priority in the healthcare process. For undergraduates, it has been proved that integrating multiple strategies in teaching EBM yields better results than a single, short-duration strategy. However, there is a lack of evidence on applying EBM educational interventions in developing countries. In this study, we aim to evaluate the effectiveness of a multiple strategy peer-taught online course in improving EBM awareness and skills among medical students in two developing countries, Syria and Egypt.

METHODS

We conducted a prospective study with pre- and post- course assessment of 84 medical students in three universities, using the Berlin questionnaire and a set of self-reported questions which studied the students' EBM knowledge, attitude and competencies. The educational intervention was a peer-taught online course consisting of six sessions (90 min each) presented over six weeks, and integrated with assignments, group discussions, and two workshops.

RESULTS

The mean score of pre- and post-course Berlin tests was 3.5 (95% CI: 2.94-4.06) and 5.5 (95% CI: 4.74-6.26) respectively, increasing by 2 marks (95% CI: 1.112-2.888; p-value <0.001), which indicates a statistically significant increase in students' EBM knowledge and skill, similar to a previous expert-taught face to face contact course. Self-reported confidences also increased significantly. However, our course did not have a major effect on students' attitudes toward EBM (1.9-10.8%; p-value: 0.12-0.99).

CONCLUSION

In developing countries, multiple strategy peer-taught online courses may be an effective alternative to face to face expert-taught courses, especially in the short term.

Education on Middle East Respiratory Syndrome and Personal Hygiene Practices of Medical Students

The purpose of this study was to inquire into the knowledge of medical students on the Middle East respiratory syndrome (MERS) and evaluate whether infection prevention education impacts students’ level of knowledge and individual hygiene practices. This study also investigated the route by which medical students obtain disease-related information. The study involved a survey conducted in August of 2015 at two medical schools in Busan. In the first year to fourth year, a total of 345 students are enrolled (111 students in A school and 234 students in B school). Before the study was carried out, university A performed infection prevention education related to MERS, but B did not. We used self-developed questionnaires to survey the demographic characteristics, routes of acquisition of MERS information, degree of knowledge of MERS, educational satisfaction, and personal hygiene practices before and after education. Knowledge level differences according to gender and year in school were not statistically significant. Students obtained their information about MERS from various news media sources and the Internet, and through social network sites. Students practiced sanitary control behaviors in an average of 2.2 manners (standard deviation=0.95). The level of knowledge of MERS revealed a positive correlation with the frequency and total numbers of personal hygiene practices. This finding suggests that the infection prevention education program played a role in knowledge acquisition and personal hygiene practices for the medical students. In order to provide accurate and reliable knowledge of disease and preventive health behavior to medical students, continuous and well-planned education programs are necessary.

Barriers to evidence-based medicine: a systematic review

INTRODUCTION

Evidence-based medicine (EBM) has emerged as an effective strategy to improve health care quality. The aim of this study was to systematically review and carry out an analysis on the barriers to EBM.

METHODS

Different database searching methods and also manual search were employed in this study using the search words ('evidence-based' or 'evidence-based medicine' or 'evidence-based practice' or 'evidence-based guidelines' or 'research utilization') and (barrier* or challenge or hinder) in the following databases: PubMed, Scopus, Web of Knowledge, Cochrane library, Pro Quest, Magiran, SID.

RESULTS

Out of 2592 articles, 106 articles were finally identified for study. Research barriers, lack of resources, lack of time, inadequate skills, and inadequate access, lack of knowledge and financial barriers were found to be the most common barriers to EBM. Examples of these barriers were found in primary care, hospital/specialist care, rehabilitation care, medical education, management and decision making. The most common barriers to research utilization were research barriers, cooperation barriers and changing barriers. Lack of resources was the most common barrier to implementation of guidelines.

CONCLUSION

The result of this study shows that there are many barriers to the implementation and use of EBM. Identifying barriers is just the first step to removing barriers to the use of EBM. Extra resources will be needed if these barriers are to be tackled.