Don't just blame the evidence: considering the role of medical education in the poor uptake of evidence-based medicine in clinical practice

Librarian-Led Assessment of Medical Students' Evidence-Based Medicine Competency: Facilitators and Barriers

Introduction

We must ensure, through rigorous assessment that physicians have the evidence-based medicine (EBM) skills to identify and apply the best available information to their clinical work. However, there is limited guidance on how to assess EBM competency. With a better understanding of their current role in EBM education, Health Sciences Librarians (HSLs), as experts, should be able to contribute to the assessment of medical student EBM competence. The purpose of this study is to explore the HSLs perspective on EBM assessment practices, both current state and potential future activities.

Methods

We conducted focus groups with librarians from across the United States to explore their perceptions of assessing EBM competence in medical students. Participants had been trained to be raters of EBM competence as part of a novel Objective Structured Clinical Examination (OSCE). This OSCE was just the starting point and the discussion covered topics of current EBM assessment and possibility for expanded responsibilities at their own institutions. We used a reflexive thematic analysis approach to construct themes from our conversations.

Results

We constructed eight themes in four broad categories that influence the success of librarians being able to engage in effective assessment of EBM: administrative, curricular, medical student, and librarian.

Conclusion

Our results inform medical school leadership by pointing out the modifiable factors that enable librarians to be more engaged in conducting effective assessment. They highlight the need for novel tools, like EBM OSCEs, that can address multiple barriers and create opportunities for deeper integration of librarians into assessment processes.

Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis

INTRODUCTION

Medical education should portray evidence-based medicine (EBM) and shared decision making (SDM) as central to patient care. However, misconceptions regarding EBM and SDM are common in clinical practice, and these biases might unintentionally be transmitted to medical trainees through a hidden curriculum. The current study explores how assumptions of EBM and SDM can be hidden in formal curriculum material such as PowerPoint slides.

METHODS

We conducted a qualitative content analysis using a purposive sample of 18 PowerPoints on the management of upper respiratory tract infections. We identified concepts pertaining to decision making using theory-driven codes taken from the fields of EBM and SDM. We then re-analyzed the coded text using a constructivist latent thematic approach to develop a rich description of conceptualizations of decision making in relation to EBM and SDM frameworks.

RESULTS

PowerPoint slides can relay a hidden curriculum, which can normalize: pathophysiological reasoning, unexplained variations in clinical care, the use of EBM mimics, defensive medicine, an unrealistic portrayal of benefits, and paternalism.

DISCUSSION

Addressing the hidden curriculum in formal curricular material should be explored as a novel strategy to foster a positive attitude towards EBM and SDM and to improve patient outcomes by encouraging the use of these skills.

Entrustable professional activity 7: opportunities to collaborate on evidence-based medicine teaching and assessment of medical students

BACKGROUND

This study was conducted to examine gaps and opportunities for involvement of librarians in medical education and patient care as well as improve the teaching and assessment of Entrustable Professional Activity 7 (EPA 7) -- the ability to form clinical questions and retrieve evidence to advance patient care.

METHODS

The Association of Academic Health Sciences Libraries (AAHSL) Competency-Based Medical Education Task Force surveyed all AAHSL member libraries in October 2016 on health sciences librarian awareness and involvement in teaching and assessing EPA 7.

RESULTS

The survey response rate was 54% (88/164 member libraries). While 90% (n = 76) of respondents were regularly engaged in teaching or assessing aspects of EPA 7 only 34 (39%) were involved explicitly in a Core EPA 7 project, 44% (15/34) of these projects were librarian initiated.

CONCLUSIONS

Involvement in teaching and assessment of EPA 7 is an untapped opportunity for librarians to collaborate in medical education and patient care. Although librarians are already deeply involved in teaching and assessment of EPA 7 related knowledge, skills, and behaviors, further librarian collaboration can help bolster the planning or updating of existing curricula and assessments of this entrustable professional activity.

Teaching evidence-based medicine application: transformative concepts of information mastery that foster evidence-informed decision-making

Information mastery is an approach to applying the methods of evidence-based medicine to everyday practice. The aim of this research is to describe concepts identified by clinicians attending a 3-day course on applied evidence-based medicine that led to 'transformative learning', in which they experienced a deep, structural shift in the basic premises of thought, feelings and actions in their approach to making medical decisions. We used a qualitative approach to capture the lived experience of 12 current and 9 prior attendees of the 'information mastery' course through individual interviews, focus groups and observation. Data were thematically analysed and themes were reported. We found that current and previous attendees who seemed to undergo transformative learning identified eight concepts that constitute an information mastery approach to medical decision-making, which we grouped into two general themes. Some participants attending this course underwent transformative learning, resulting in an alternative decision-making process no longer relying on the anecdotes or guidance of others (what 'ought to work') and instead on incorporating patient-oriented outcomes based on the best evidence (what 'does work').