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Terrani K, Ibrahim R, Brucks E. Integrating evidence-based medicine into resident education. J Investig Med 2023; 71:804-812. [PMID: 37485968 DOI: 10.1177/10815589231189489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Evidence-based medicine (EBM) is the practice of applying scientific evidence to clinical decision-making, with a focus on addressing the individualized needs and values of patients. It requires not only a solid foundation of medical knowledge and the ability to gather a thorough patient history but also the skills to locate, interpret, and apply relevant principles from the medical literature. Given the rapid advancements in the field of medicine, understanding medical literature holds significant importance for residents during their education and future careers. It is particularly crucial for reducing medical waste, adhering to guidelines, and decreasing morbidity and mortality rates. This paper aims to underscore the significance of increasing residents' exposure to evidence-based approaches in clinical decision-making, propose time-efficient and effective methods to enhance their understanding of EBM, and promote the implementation of evidence-based practices within the inpatient setting.
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Affiliation(s)
- Kristina Terrani
- University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona - Banner University Medical Center, Tucson, AZ, USA
| | - Eric Brucks
- Department of Medicine, University of Arizona - Banner University Medical Center, Tucson, AZ, USA
- Department of Medicine, Southern Arizona VA Health Care System, Tucson, AZ, USA
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Ban JW, Perera R, Williams V. Influence of research evidence on the use of cardiovascular clinical prediction rules in primary care: an exploratory qualitative interview study. BMC PRIMARY CARE 2023; 24:194. [PMID: 37730553 PMCID: PMC10512575 DOI: 10.1186/s12875-023-02155-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Cardiovascular clinical prediction rules (CPRs) are widely used in primary care. They accumulate research evidence through derivation, external validation, and impact studies. However, existing knowledge about the influence of research evidence on the use of CPRs is limited. Therefore, we explored how primary care clinicians' perceptions of and experiences with research influence their use of cardiovascular CPRs. METHODS We conducted an exploratory qualitative interview study with thematic analysis. Primary care clinicians were recruited from the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region Practice and Research Network (WPRN). We used purposeful sampling to ensure maximum variation within the participant group. Data were collected by conducting semi-structured online interviews. We analyzed data using inductive thematic analysis to identify commonalities and differences within themes. RESULTS Of 29 primary care clinicians who completed the questionnaire, 15 participated in the interview. We identified two main themes relating to the influence of clinicians' perceptions of and experiences with cardiovascular CPR research on their decisions about using cardiovascular CPRs: "Seek and judge" and "be acquainted and assume." When clinicians are familiar with, trust, and feel confident in using research evidence, they might actively search and assess the evidence, which may then influence their decisions about using cardiovascular CPRs. However, clinicians, who are unfamiliar with, distrust, or find it challenging to use research evidence, might be passively acquainted with evidence but do not make their own judgment on the trustworthiness of such evidence. Therefore, these clinicians might not rely on research evidence when making decisions about using cardiovascular CPRs. CONCLUSIONS Clinicians' perceptions and experiences could influence how they use research evidence in decisions about using cardiovascular CPRs. This implies, when promoting evidence-based decisions, it might be useful to target clinicians' unfamiliarity, distrust, and challenges regarding the use of research evidence rather than focusing only on their knowledge and skills. Further, because clinicians often rely on evidence-unrelated factors, guideline developers and policymakers should recommend cardiovascular CPRs supported by high-quality evidence.
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Affiliation(s)
- Jong- Wook Ban
- Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK.
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Annaswamy TM, Rizzo JR, Schnappinger A, Morgenroth DC, Engkasan JP, Ilieva E, Arnold WD, Boninger ML, Bean AC, Cirstea CM, Dicianno BE, Fredericson M, Jayabalan P, Raghavan P, Sawaki L, Suri P, Suskauer SJ, Wang QM, Hosseini M, Case CM, Whyte J, Paganoni S. Evidence-Based Medicine Training in United States-Based Physiatry Residency Programs. Am J Phys Med Rehabil 2022; 101:S40-S44. [PMID: 33852491 PMCID: PMC9444380 DOI: 10.1097/phm.0000000000001752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies. However, although most respondents reported using traditional pedagogic methods of training such as journal club, very few reported that their EBM training used a structured and systematic approach. Future work is needed to support and facilitate physiatry residency programs interested in adopting structured EBM training curricula that include recommended EBM core competencies and the evaluation of their impact.
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Affiliation(s)
- Thiru M Annaswamy
- From the PM&R Service, VA North Texas Health Care System, Dallas, Texas (TMA); Department of PM&R, UT Southwestern Medical Center, Dallas, Texas (TMA); Departments of Rehabilitation Medicine and Neurology, New York University Langone Health, New York City, New York (J-RR); Association of Academic Physiatrists, Owings Mills, Maryland (AS); VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington (DCM); Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (DCM, PS); Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia (JPE); Department of Physical and Rehabilitation Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria (EI); Departments of Neurology, PM&R, Neuroscience, and Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio (WDA); Department of PM&R, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (MLB, ACB, BED); Department of Physical Medicine & Rehabilitation, University of Missouri, Columbia, Missouri (CM Cirstea); Division of PM&R, Stanford University School of Medicine, Stanford, California (MF); Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois (PJ); Johns Hopkins School of Medicine, Baltimore, Maryland (PR); Department of PM&R, University of Kentucky, Lexington, Kentucky (LS); Seattle Epidemiologic Research and Information Center and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington (PS); Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington (PS); Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Kennedy Krieger Institute, Baltimore, Maryland (SJS); Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts (QMW, SP); Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (MH); Creighton University, Omaha, Nebraska (CM Case); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (JW); and Healey & AMG Center for ALS and Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, Massachusetts (SP)
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Knowledge, Attitude, and Practice of Evidence-Based Medicine among Emergency Doctors in Kelantan, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111297. [PMID: 34769813 PMCID: PMC8583382 DOI: 10.3390/ijerph182111297] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to determine the prevalence of high levels of knowledge, positive attitude, and good practice on evidence-based medicine (EBM) and identify the associated factors for practice score on EBM among emergency medicine doctors in Kelantan, Malaysia. This cross-sectional study was conducted in government hospitals in Kelantan. The data were collected from 200 emergency physicians and medical officers in the emergency department using the Noor Evidence-Based Medicine Questionnaire. Simple and general linear regressions analyses using SPSS were performed. A total of 183 responded, making a response rate of 91.5%. Of them, 49.7% had a high level of knowledge, 39.9% had a positive attitude and 2.1% had good practice. Sex, race, the average number of patients seen per day, internet access in workplace, having online quick reference application, and attitude towards EBM were significantly associated with EBM practice scores. It is recommended that appropriate authorities provide emergency doctors with broader access to evidence resources. EBM skill training should be enhanced in the current medical school curriculums.
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Drum BM, Sheffield CR, Mulcaire-Jones J, Gradick C. Formation and Evaluation of an Academic Elective for Residents in a Combined Internal Medicine-Pediatrics Residency Program. Cureus 2021; 13:e16287. [PMID: 34381647 PMCID: PMC8349692 DOI: 10.7759/cureus.16287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Recently, there has been increasing focus on skills that are crucial for success in residency that is not explicitly taught. Specifically, the four domains of teaching skills, evidence appraisal, wellness, and education on structural racism have been identified as topics that are important and underrepresented in current resident education curriculums, largely due to time constraints. Methods A task force consisting of one post-graduate year 2 (PGY-2) resident, one PGY-4 resident, the Associate Program Director, and the Program Director of the Internal Medicine-Pediatrics residency program was formed to explore current deficiencies in resident curriculum and to research possible solutions. As an intervention, we created and executed a four-week academic elective with dedicated time for upper-level residents to learn and explore the four domains of resident teaching, evidence-based clinical practice, wellness, and anti-racism work. The elective included several clinical sessions dedicated to implementing the skills taught in the elective. The month-long elective completed in January 2021. All residents evaluated each lecture or experience based on how valuable it was to their education on a Likert scale from 1 to 7, with 1 defined as “not valuable at all” and 7 defined as “extremely valuable.” Results Residents rated the overall value of teaching in each domain highly. Education and activities in wellness lectures were found to have the highest value-added material (6.20 ± 0.41, n = 18), followed by residents-as-teachers lectures (5.93 ± 0.25, n = 48), anti-racism (5.57 ± 1.11, n = 9), and evidence-based clinical practice (5.18 ± 0.50, n = 43). In addition, each domain was found to have at least one high-yield topic. Conclusions We were able to create and execute an academic elective with dedicated time for upper-level residents to develop and utilize valuable skills in teaching, evidence appraisal, wellness, and anti-racism. Future work will focus on refining the curriculum based on resident evaluations and expanding this elective to the Internal Medicine and Pediatrics categorical programs at our institution.
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Affiliation(s)
- Benjamin M Drum
- Internal Medicine-Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Clinton R Sheffield
- Internal Medicine-Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - John Mulcaire-Jones
- Pediatric Critical Care, University of Utah School of Medicine, Salt Lake City, USA
| | - Casey Gradick
- Internal Medicine-Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
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Development and Validation of a Test for Competence in Evidence-Based Medicine. J Gen Intern Med 2020; 35:1530-1536. [PMID: 31848856 PMCID: PMC7210361 DOI: 10.1007/s11606-019-05595-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/24/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Medical educators need valid, reliable, and efficient tools to assess evidence-based medicine (EBM) knowledge and skills. Available EBM assessment tools either do not assess skills or are laborious to grade. OBJECTIVE To validate a multiple-choice-based EBM test-the Resident EBM Skills Evaluation Tool (RESET). DESIGN Cross-sectional study. PARTICIPANTS A total of 304 medicine residents from five training programs and 33 EBM experts comprised the validation cohort. MAIN MEASURES Internal reliability, item difficulty, and item discrimination were assessed. Construct validity was assessed by comparing mean total scores of trainees to experts. Experts were also asked to rate importance of each test item to assess content validity. KEY RESULTS Experts had higher total scores than trainees (35.6 vs. 29.4, P < 0.001) and also scored significantly higher than residents on 11/18 items. Cronbach's alpha was 0.6 (acceptable), and no items had a low item-total correlation. Item difficulty ranged from 7 to 86%. All items were deemed "important" by > 50% of experts. CONCLUSIONS The proposed EBM assessment tool is a reliable and valid instrument to assess competence in EBM. It is easy to administer and grade and could be used to guide and assess interventions in EBM education.
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Chhabra S. Challenges in health professionals’ training and health care for wellness. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1641951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Chhabra
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
- Dr Sushila Nayar Hospital, Melghat, India
- Aakanksha Shishu Gruha, Kasturba Health Society, Sevagram, India
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Cochrane, evidence-based medicine and associated factors: A cross-sectional study of the experiences and knowledge of Ethiopian specialists in training. Afr J Emerg Med 2019; 9:70-76. [PMID: 31193814 PMCID: PMC6543079 DOI: 10.1016/j.afjem.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/09/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Evidence-based healthcare is a core competency for practicing healthcare practitioners and those in speciality training. In sub-Saharan Africa, little is known about the teaching of evidence-based medicine (EBM) in residency program. This survey evaluated the experiences and knowledge of Cochrane, EBM and associated factors among Ethiopian specialists in training. METHODS A convenient sample of trainee specialists completed a pretested self-administered survey. The majority (93%) were ≤30 years old, males (63%) and 41% in paediatrics speciality. The associations of categorical variables with EBM knowledge was assessed by Fisher's exact or Chi-Square tests. Covariates contributing to EBM knowledge were identified using multivariate logistic regression analysis. RESULTS Eighty-three trainees participated in the survey (response rate 88.2%). About 75% have heard about Cochrane but no one recognized Cochrane South Africa. Only 25% of the trainees knew the Cochrane Library but none used it in clinical practice. Most (78%) have heard of EBM, 15% had attended EBM course, 96% wanted to attend EBM course and 81% had positive attitudes to EBM. Trainees EBM knowledge was associated with awareness of Cochrane [Adjusted odds ratio (AOR) = 8.5, 95% Confidence interval (CI) 1.3-54.6, P = 0.02], EBM (AOR = 51.2, 95% CI 2.7-960.8, P = 0.009), and being in third year training (AOR = 28.4, 95% CI 1.9-427.2, P = 0.02). The promotion of EBM in residency hospital (AOR = 22.2, 95% CI 2.2-223.8, P = 0.008) and being aware of Cochrane (AOR = 4.8, 95% CI 1.1-21.7, P = 0.04) were predictors of positive attitude. Familiarity with Cochrane Library was influenced by EBM knowledge (AOR = 6.6, 95% CI 1.4-31.5, P = 0.02) and perceived organization barrier to accessing the resource (AOR = 3.2, 95% CI 1.03-10.1, P = 0.04). CONCLUSION Ethiopian trainee specialists lacked formal EBM training, awareness and use of the Cochrane Library. To improve the healthcare quality and patient outcomes, EBM education should be integrated into residency curricula.
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Aneese AM, Nasr JA, Halalau A. A prospective mixed-methods study evaluating the integration of an evidence based medicine curriculum into an internal medicine residency program. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:533-546. [PMID: 31413652 PMCID: PMC6659792 DOI: 10.2147/amep.s203334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/08/2019] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Evidence based medicine (EBM) skills are often lacking in the general internal medicine physician population. Our aim is to evaluate the impact of our internal medicine EBM curriculum on the residents' EBM skills and knowledge through mixed methods. METHODS A prospective study was performed that evaluated the EBM curriculum: quantitatively, with pre/posttests and qualitatively through a focus group that addressed residents' opinion on the educational and clinical impact of each aspect of the curriculum. RESULTS A total of 60 internal medicine residents were surveyed. Short-term EBM skills: therapy workshops (N=25) median pretest score of 8 (IQR): [6-9]) vs posttest 8 (IQR: [8-9]), (p=0.006); diagnosis (N=16) pretest score of 6 (IQR: [3-6]) vs posttest 7 (IQR: [6-9]), (p=0.006); systematic review (N=13) pretest score of 4 (IQR: [4-6]) vs posttest 7 (IQR: [6-8]), (p=0.002); and harm (N=16) pretest score of 6 (IQR: [5-7]) vs posttest 7 (IQR: [7-8]), (p=0.004). Long-term EBM skills: Fresno test of competence in EBM, pretest median score of 110.5/212 (IQR: 96.0-124.0) and a median posttest score of 115/212 (IQR: 100.0-130.0) (p=0.60). Having previous EBM training, being actively involved in research and being the first author on a publication was associated with higher Fresno test scores. Focus group provided qualitative feedback on the residents' EBM curriculum perception. CONCLUSION This curriculum adds a significant contribution to the current field of medical education as it fills an important educational gap, through defining ways of effectively delivering EBM concepts which led to improvement in residents' ability to evaluate and apply medical literature. The EBM curriculum was overall well received by the residents.
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Affiliation(s)
- Andrew M Aneese
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI48073, USA
| | - Justine A Nasr
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI48073, USA
- Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI48309, USA
| | - Alexandra Halalau
- Department of Internal Medicine, Beaumont Health, Royal Oak, MI48073, USA
- Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI48309, USA
- Correspondence: Alexandra HalalauDepartment of Internal Medicine, Beaumont Health, 3601 W 13 Mile Road, Royal Oak, Michigan, USATel +1 248 551 3481Email
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Nasr JA, Falatko J, Halalau A. The impact of critical appraisal workshops on residents' evidence based medicine skills and knowledge. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2018; 9:267-272. [PMID: 29713212 PMCID: PMC5912372 DOI: 10.2147/amep.s155676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the impact of four evidence based medicine (EBM) critical appraisal education workshops in improving residents' EBM knowledge and skills. METHODS The eligible participants in the workshops were 88 residents-in-training, postgraduate years one through four, rotating through the outpatient internal medicine clinic. Four EBM workshops, consisting of 3 days each (30 minutes daily), were taught by our faculty. Topics covered included critical appraisal of randomized controlled trials, case-control and cohort studies, diagnosis studies, and systematic reviews. RESULTS As a program evaluation, anonymous pre-workshop and post-workshop tests were administered. Each of the four sets of tests showed improvement in scores: therapy from 58% to 77% (42% response rate), harm from 65% to 73% (38% response rate), diagnosis from 49% to 68% (49% response rate), and systematic review from 57% to 72% (30% response rate). CONCLUSION We found that teaching EBM in four short workshops improved EBM knowledge and critical appraisal skills related to the four topics.
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Affiliation(s)
- Justine A Nasr
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
- Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - John Falatko
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
| | - Alexandra Halalau
- Internal Medicine Department, Beaumont Hospital, Royal Oak, MI, USA
- Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Plastic Surgery Residents' Understanding and Attitudes Toward Biostatistics: A National Survey. Ann Plast Surg 2017; 77:231-6. [PMID: 25643191 DOI: 10.1097/sap.0000000000000386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND An understanding of biostatistics is a critical skill for the practicing plastic surgeon. The purpose of the present study was to assess plastic surgery residents' attitudes and understanding of biostatistics. METHODS This was a cross-sectional study of plastic surgery residents. A survey assessing resident attitudes regarding biostatistics, confidence with biostatistical concepts, and objective knowledge of biostatistics was distributed electronically to trainees in plastic surgery programs in the United States. Bivariate and regression analyses were used to identify significant associations and adjust for confounders/effect modifiers. RESULTS One hundred twenty-three residents responded to the survey (12.3% response rate). Respondents expressed positive attitudes regarding biostatistics in plastic surgery practice, but only moderate levels of confidence with various biostatistical concepts. Both attitudes and confidence were positively associated with the number of plastic surgery journals read monthly and formal coursework in biostatistics (P < 0.01). Resident attitudes were positively correlated with confidence (r = 0.33, P < 0.01). The mean percentage of correct responses on knowledge-assessments was 43.6% (20.8%). Integrated residents performed better than independent track residents (P = 0.04). Residents had difficulty with study design, the correct use of analysis of variance, regression analysis, and identifying a statistically significant result. Resident confidence was moderately correlated with performance (r = 0.31, P = 0.01). CONCLUSIONS Plastic surgery residents place a high degree of importance on knowledge of biostatistics in the practice of plastic surgery but have only a fair understanding of core statistical concepts.
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Nelson B, Ingard C, Nelson D. Teaching trainees how to critically evaluate the literature - a crossover study at two pediatric residency programs. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:137-141. [PMID: 28441140 PMCID: PMC5420458 DOI: 10.5116/ijme.58ce.5f04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/19/2017] [Indexed: 05/12/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the efficacy of a concise, evidence based medicine curriculum in improving the knowledge of pediatric residents at two institutions. METHODS Sixty first and second year pediatric residents at MassGeneral Hospital for Children and MedStar Georgetown University Hospital participated in a crossover study. The evidence based medicine curriculum, consisting of 4 ninety minute sessions grounded in adult learning theory principles, was developed using the methodology described in the book 'Studying a Study'. A validated 20 question evidence based medicine multiple choice test was administered on three separate occasions to measure baseline knowledge, efficacy of the curriculum in improving knowledge, and long term retention of that knowledge. RESULTS Post curriculum, the fall group's scores improved 23% from baseline (M=10.3, SD=2.4) to (M=12.7, SD=3.0) students (t(26)=-3.29, p=0.0018) while the spring group improved by 41% (M=10.0, SD=2.8) to (M=14.1, SD=2.2) students (t(32)=-6.46, p<0.0001). When re-tested 4-6 months later, the fall group's scores did not significantly decline from their immediate post curriculum scores (M=12.7, SD=3.0) to (M=11.7, SD=3.0) students (t(32) =1.33, p=0.190). There was an association between number of sessions attended and increase in post curriculum score (χ2(3, N=60) =11.75, p=0.0083). CONCLUSIONS Findings demonstrate our curriculum was effective in teaching evidence based medicine to pediatric residents, and fostered long term retention of knowledge. Based on these results, we believe this curriculum could be implemented at any institution.
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Affiliation(s)
- Benjamin Nelson
- Department of Pediatric Pulmonology, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Catherine Ingard
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
| | - David Nelson
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA
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Alavi-Moghaddam M, Yazdani S, Mortazavi F, Chichi S, Hosseini-Zijoud SM. Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills? Chonnam Med J 2016; 52:107-11. [PMID: 27231674 PMCID: PMC4880574 DOI: 10.4068/cmj.2016.52.2.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 03/15/2016] [Accepted: 03/24/2016] [Indexed: 11/06/2022] Open
Abstract
This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.
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Affiliation(s)
- Mostafa Alavi-Moghaddam
- Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Yazdani
- School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fathie Mortazavi
- School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Chichi
- Department of Biostatistics, Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Mostafa Hosseini-Zijoud
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Amini R, Hernandez NC, Keim SM, Gordon PR. Using standardized patients to evaluate medical students' evidence-based medicine skills. J Evid Based Med 2016; 9:38-42. [PMID: 26646923 DOI: 10.1111/jebm.12183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 12/15/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To analyze the effectiveness of an Evidence Based Medicine Objective Structured Clinical Examination (EBM OSCE) with standardized patients for end of third year medical students at our institution. METHODS This was a single-center prospective cross-sectional investigation. As part of the eight-station OSCE exam, the authors developed and implemented a new 25-minute EBM OSCE station with the goal of evaluating evidence based medicine skills necessary for daily clinical encounters. The OSCE case involved a highly educated patient with a history of recurrent debilitating migraines who has brought eight specific questions regarding the use of steroids for migraine headaches. Students were provided computer stations equipped to record a log of the searches performed. RESULTS One hundred and four third-year medical students participated in this study. The average number of search tools used by the students was 4 (SD = 2). The 104 students performed a total of 896 searches. The two most commonly used websites were uptodate.com and google.com. Sixty-nine percent (95% CI, 60% to 78%) of students were able to find a meta-analysis regarding the use of dexamethasone for the prevention of rebound migraines. Fifty-two percent of students were able to explain that patients who took dexamethasone had a moderate RR (0.68 to 0.78) of having a recurrent migraine, and 71% of students were able to explain to the standardized patient that the NNT for dexamethasone was nine. CONCLUSION The EBM OSCE was successfully integrated into the existing eight-station OSCE and was able to assess student EBM skills.
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Affiliation(s)
- Richard Amini
- Department of Emergency Medicine, University of Arizona, Tucson, AZ
| | | | - Samuel M Keim
- Department of Emergency Medicine, University of Arizona, Tucson, AZ
| | - Paul R Gordon
- Department of Family Medicine, University of Arizona, Tucson, AZ
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Barz DL, Achimaş-Cadariu A. The development of scientific reasoning in medical education: a psychological perspective. ACTA ACUST UNITED AC 2016; 89:32-7. [PMID: 27004023 PMCID: PMC4777466 DOI: 10.15386/cjmed-530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/01/2015] [Indexed: 11/23/2022]
Abstract
Scientific reasoning has been studied from a variety of theoretical perspectives, which have tried to identify the underlying mechanisms responsible for the development of this particular cognitive process. Scientific reasoning has been defined as a problem-solving process that involves critical thinking in relation to content, procedural, and epistemic knowledge. The development of scientific reasoning in medical education was influenced by current paradigmatic trends, it could be traced along educational curriculum and followed cognitive processes. The purpose of the present review is to discuss the role of scientific reasoning in medical education and outline educational methods for its development. Current evidence suggests that medical education should foster a new ways of development of scientific reasoning, which include exploration of the complexity of scientific inquiry, and also take into consideration the heterogeneity of clinical cases found in practice.
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Affiliation(s)
- Daniela Luminita Barz
- Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andrei Achimaş-Cadariu
- Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ibrahim A, Mshelbwala PM, Mai A, Asuku ME, Mbibu HN. Perceived role of the journal clubs in teaching critical appraisal skills: a survey of surgical trainees in Nigeria. Niger J Surg 2014; 20:64-8. [PMID: 25191095 PMCID: PMC4141447 DOI: 10.4103/1117-6806.137292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Critical appraisal skills allow surgeons to evaluate the literature in an objective and structured manner, with emphasis on the validity of the evidence. The development of skills in critical acquisition and appraisal of the literature is crucial to delivering quality surgical care. It is also widely accepted that journal clubs are a time-honored educational paradigm for teaching and development of critical appraisal skills. The aim of this study is to determine the perceived role of journal clubs in teaching critical appraisal skills amongst the surgical trainees in Nigeria. MATERIALS AND METHODS The West African College of Surgeons and the National Postgraduate College of Nigeria have mandated that all residency programs teach and assess the ability to develop critical appraisal skills when reviewing the scientific literature. Residents at the revision course of the West African College of Surgeons in September 2012 evaluated the role of journal clubs in teaching critical appraisal skills using a 17-item questionnaire. The questionnaire addressed four areas: Format, teaching and development of critical appraisal s kills, and evaluation. RESULTS Most of the journal clubs meet weekly [39 (59%)] or monthly [25 (38%)]. Thirty-nine residents (59%) perceived the teaching model employed in the development of critical appraisal skills in their institutions was best characterized by "iscussion/summary by consultants" and "emphasis on formal suggestion for improvement in research." Rating the importance of development of critical appraisal skills to the objectives of the residency program and practice of evidence-based medicine, majority of the residents [65 (98%)] felt it was "very important." The commonest form of feedback was verbal from the consultants and residents [50 (76%)]. CONCLUSION The perceived importance of journal clubs to the development of critical appraisal skills was rated as very important by the residents. However, residents indicated a need for a formal evaluation of the journal clubs. It is our hope that the results of this survey will encourage postgraduate coordinators to evaluate the quality of their journal clubs in the development of skills in critical appraisal of the literature.
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Affiliation(s)
- Abdulrasheed Ibrahim
- Department of Surgery, Divisions of Plastic Surgery, Ahmadu Bello University, Zaria, Nigeria
| | | | - Ahmed Mai
- Department of General Surgery, Ahmadu Bello University, Zaria, Nigeria
| | - Malachy E Asuku
- Department of Surgery, Divisions of Plastic Surgery, Ahmadu Bello University, Zaria, Nigeria
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Li T, Saldanha IJ, Vedula SS, Yu T, Rosman L, Twose C, N Goodman S, Dickersin K. Learning by doing-teaching systematic review methods in 8 weeks. Res Synth Methods 2014; 5:254-63. [PMID: 26052850 DOI: 10.1002/jrsm.1111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this paper is to describe the course "Systematic Reviews and Meta-analysis" at the Johns Hopkins Bloomberg School of Public Health. METHODS A distinct feature of our course is a group project in which students, assigned to multi-disciplinary groups, conduct a systematic review. In-class sessions comprise didactic lectures, hands-on exercises, demonstrations, discussion, and group work. Students also work outside of class to complete the systematic review. Students evaluated the course at the end of the term. We also surveyed students from 2004 to 2012 to learn more about the long-term impact of the course. RESULTS The course has been offered to more than 800 students since 1995. In our view, aspects that worked well include the hands-on approach, students working in a multidisciplinary group, intensive interaction with the teaching team, moving to an online approach, and continuous updates of the course content. A persistent issue is the constraint of time. 193 of 211 (91%) survey participants reported that the course is currently useful or as having an impact on their work. CONCLUSIONS Our experiences have led us to remain committed to a hands-on approach. Our course serves as a bridge between classroom learning and real-world practice, and provides an example of teaching systematic review.
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Affiliation(s)
- Tianjing Li
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Ian J Saldanha
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - S Swaroop Vedula
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Tsung Yu
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Lori Rosman
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Claire Twose
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Steven N Goodman
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Kay Dickersin
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Susarla SM, Redett RJ. Plastic surgery residents' attitudes and understanding of biostatistics: a pilot study. JOURNAL OF SURGICAL EDUCATION 2014; 71:574-579. [PMID: 24835297 DOI: 10.1016/j.jsurg.2013.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/05/2013] [Accepted: 12/12/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess plastic surgery residents' knowledge, attitudes, and comfort with biostatistics. DESIGN Cross-sectional study. SETTING Department of Plastic and Reconstructive Surgery at Johns Hopkins Hospital. PARTICIPANTS A total of 22 plastic surgery residents (91% response rate) completed the study. RESULTS The study sample consisted of 18 residents in the integrated training path and 4 in the independent training track and was equally divided between junior and senior residents. Most respondents (>54%) had taken at least 1 course in biostatistics or epidemiology. More than 90% of residents reported reading at least 1 plastic surgical journal on a regular basis (mean 2.1 ± 1.5 journals/month). Most residents expressed a desire to learn more about biostatistics (68.2%), reported using statistical information in forming clinical opinions (86.3%), and placed a high value on knowledge of biostatistics in appraising the surgical literature (90.9%). However, only 45% of respondents reported being able to understand all the statistical terms encountered in journal articles. Only 50% of respondents felt comfortable with assessing whether the appropriate statistical tests were used to answer a research question. In case studies, the mean percentage of correct responses was 53.0 ± 24.5% (range: 0-83.3). Higher performance scores were associated with a prior course in biostatistics (p = 0.04) and the number of journals read monthly (p = 0.003). Respondents had difficulty with study design (45.5% correct), analysis of variance (45.5% correct), time to event analysis (9.1% correct), and interpreting a 95% confidence interval (45.5% correct). The number of correct responses strongly correlated with respondent confidence in biostatistics (r = 0.70, p < 0.001). CONCLUSION Plastic surgery residents place a high degree of importance on biostatistics but have only a fair understanding of core statistical concepts.
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Affiliation(s)
- Srinivas M Susarla
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland.
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Johns Hopkins University, Baltimore, Maryland
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Kim S, Noveck H, Galt J, Hogshire L, Willett L, O'Rourke K. Searching for answers to clinical questions using google versus evidence-based summary resources: a randomized controlled crossover study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:940-3. [PMID: 24871247 DOI: 10.1097/acm.0000000000000244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE To compare the speed and accuracy of answering clinical questions using Google versus summary resources. METHOD In 2011 and 2012, 48 internal medicine interns from two classes at Rutgers University Robert Wood Johnson Medical School, who had been trained to use three evidence-based summary resources, performed four-minute computer searches to answer 10 clinical questions. Half were randomized to initiate searches for answers to questions 1 to 5 using Google; the other half initiated searches using a summary resource. They then crossed over and used the other resource for questions 6 to 10. They documented the time spent searching and the resource where the answer was found. Time to correct response and percentage of correct responses were compared between groups using t test and general estimating equations. RESULTS Of 480 questions administered, interns found answers for 393 (82%). Interns initiating searches in Google used a wider variety of resources than those starting with summary resources. No significant difference was found in mean time to correct response (138.5 seconds for Google versus 136.1 seconds for summary resource; P = .72). Mean correct response rate was 58.4% for Google versus 61.5% for summary resource (mean difference -3.1%; 95% CI -10.3% to 4.2%; P = .40). CONCLUSIONS The authors found no significant differences in speed or accuracy between searches initiated using Google versus summary resources. Although summary resources are considered to provide the highest quality of evidence, improvements to allow for better speed and accuracy are needed.
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Affiliation(s)
- Sarang Kim
- Dr. Kim is clinical associate professor, Department of Medicine, Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey. Ms. Noveck is research teaching specialist, Department of Medicine, Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey. Mr. Galt is curriculum development/instructional design specialist, Robert Wood Johnson Library of the Health Sciences, Rutgers University, New Brunswick, New Jersey. Dr. Hogshire is clinical instructor, Department of Medicine, Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey. Dr. Willett is associate professor, Department of Medicine, Rutgers University Robert Wood Johnson Medical School, New Brunswick, New Jersey. Ms. O'Rourke is library director, Robert Wood Johnson Library of the Health Sciences, Rutgers University, New Brunswick, New Jersey
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Kenari MA. Effect of Evidence-Based Method Clinical Education on Patients Care Quality and Their Satisfaction. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/aasoci.2014.42010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gavino AI, Ho BLC, Wee PAA, Marcelo AB, Fontelo P. Information-seeking trends of medical professionals and students from middle-income countries: a focus on the Philippines. Health Info Libr J 2013; 30:303-17. [PMID: 24251892 DOI: 10.1111/hir.12032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 04/29/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased emphasis has been given to the practice of evidence-based medicine (EBM) worldwide. Access to quality health information is essential to the practice of EBM in developing countries. OBJECTIVES To understand the information needs and sources of information of physicians from low- and middle-income countries (LMICs). METHODS Medical doctors and students participated in an 18-question online or paper study. RESULTS Of the 156 respondents from six LMICs, 146 (94%) came from the Philippines. Eighty-eight per cent encountered at least one clinical question daily, while 58% were very likely to search for answers. A basic mobile phone was the most used device at home (94%) and at work (82%). More than half had Internet connectivity at home (62%) and just under half at work (46%). In decreasing order, short messaging services (SMS), email, instant messaging and multimedia messaging services (MMS) were the most commonly used messaging tools at home and at work. The primary source for medication questions was a formulary, but for diagnostic dilemmas, colleagues were consulted first. PubMed use was high for therapy and management questions. CONCLUSION The use of health information from the Internet through mobile devices may be increasing. Access to health information was higher at home than at work. These results may be useful when planning resources for healthcare givers in resource-poor settings.
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Duran-Nelson A, Gladding S, Beattie J, Nixon LJ. Should we Google it? Resource use by internal medicine residents for point-of-care clinical decision making. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:788-94. [PMID: 23619072 DOI: 10.1097/acm.0b013e31828ffdb7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC. METHOD In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey regarding resources used for POC decision making. Resource use frequency and factors influencing choice were determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships between the independent variables. RESULTS A total of 167 residents (56%) responded; similar numbers responded at each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85% and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection. Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases, whereas Google Scholar, used by 30% of residents, tended to be used for treatment and management decisions or locating a journal article. CONCLUSIONS The findings suggest that internal medicine residents use UpToDate most frequently, followed by consultation with faculty and the search engines Google and Google Scholar; speed, trust, and portability are the biggest drivers for resource selection; and time and information overload appear to be the biggest barriers to resources such as Ovid MEDLINE. Residents frequently used Google and may benefit from further training in information management skills.
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Affiliation(s)
- Alisa Duran-Nelson
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
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Abstract
As 21st century health care moves from a disease-based approach to a more patient-centric system that can address biochemical individuality to improve health and function, clinical decision making becomes more complex. Accentuating the problem is the lack of a clear standard for this more complex functional medicine approach. While there is relatively broad agreement in Western medicine for what constitutes competent assessment of disease and identification of related treatment approaches, the complex functional medicine model posits multiple and individualized diagnostic and therapeutic approaches, most or many of which have reasonable underlying science and principles, but which have not been rigorously tested in a research or clinical setting. This has led to non-rigorous thinking and sometimes to uncritical acceptance of both poorly documented diagnostic procedures and ineffective therapies, resulting in less than optimal clinical care.
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Affiliation(s)
- Joseph E Pizzorno
- Joseph E. Pizzorno, Jr, ND, is the editor in chief of the peer reviewed journal Integrative Medicine: A Clinician's Journal and coauthor of the critically acclaimed Textbook of Natural Medicine . He is the founding president of Bastyr University, vice chair of the board of the Institute for Functional Medicine, Gig Harbor, Washington, and chair of the science board for Bioclinic Naturals, Coquitlam, British Columbia, Canada
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Tomatis C, Taramona C, Rizo-Patrón E, Hernández F, Rodríguez P, Piscoya A, Gonzales E, Gotuzzo E, Heudebert G, Centor RM, Estrada CA. Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships. J Eval Clin Pract 2011; 17:644-50. [PMID: 21276140 PMCID: PMC3145831 DOI: 10.1111/j.1365-2753.2011.01635.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges. METHOD Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high). RESULTS Totally 220 clinicians participated. For phase I (2005-2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008-2009), before the course, 8-72% graded their competence very low (score of 1-2). After the course, 67-92% of subjects graded their increase in knowledge very high (score of 4-5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed. CONCLUSIONS In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.
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Khader YS, Batayha W, Al-Omari M. The effect of evidence-based medicine (EBM) training seminars on the knowledge and attitudes of medical students towards EBM. J Eval Clin Pract 2011; 17:640-3. [PMID: 21114803 DOI: 10.1111/j.1365-2753.2010.01604.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is debate about the most effective method for teaching evidence-based medicine (EBM) in medical schools. This study was conducted to evaluate the effect of integration of EBM training seminars into the curriculum of the community medicine course in changing the knowledge and attitudes of the fourth year medical students towards EBM. METHODS This is a quasi-experimental study conducted on the fourth year medical students who joined the community medicine mandatory summer course at Jordan University of Science and Technology in the period between July 1 and August 31, 2008. We measured medical students' self-reported attitudes about and knowledge of EBM before the integration of EBM seminars into the community medicine course and at the end of course. RESULTS A high proportion of students had positive attitude towards EBM before and after the course. After the course, the vast majority (91.8%) became aware of the presence of guidelines and protocols for diseases compared with 59.0% who were aware of that before (P < 0.005). Only small proportion of students reported that they understand and able to explain the common epidemiological concepts that are used in EBM before the training. After the training, a significantly higher proportion of students reported understanding the epidemiological concepts. CONCLUSION Integration of EBM training course into community course for the fourth year students improved their EBM knowledge. Longitudinal studies are needed to evaluate the long-term effects of EBM curriculum in changing behaviours, practice patterns and patient care outcome.
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Affiliation(s)
- Yousef S Khader
- Faculty of Medicine, Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan.
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Abstract
Understanding statistical terminology and the ability to appraise clinical research findings and statistical tests are critical to the practice of evidence-based medicine. Urologists require statistics in their toolbox of skills in order to successfully sift through increasingly complex studies and realize the drawbacks of statistical tests. Currently, the level of evidence in urology literature is low and the majority of research abstracts published for the American Urological Association (AUA) meetings lag behind for full-text publication because of a lack of statistical reporting. Underlying these issues is a distinct deficiency in solid comprehension of statistics in the literature and a discomfort with the application of statistics for clinical decision-making. This review examines the plight of statistics in urology and investigates the reason behind the white-coat aversion to biostatistics. Resources such as evidence-based medicine websites, primers in statistics, and guidelines for statistical reporting exist for quick reference by urologists. Ultimately, educators should take charge of monitoring statistical knowledge among trainees by bolstering competency requirements and creating sustained opportunities for statistics and methodology exposure.
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Affiliation(s)
- Arun S Sivanandam
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, United States
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Banzai R, Derby DC, Long CR, Hondras MA. International web survey of chiropractic students about evidence-based practice: a pilot study. Chiropr Man Therap 2011; 19:6. [PMID: 21371309 PMCID: PMC3058064 DOI: 10.1186/2045-709x-19-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 03/03/2011] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Positive attitude toward evidence-based practice (EBP) principles in healthcare education may be one of the first steps for motivating a healthcare professional student to later apply EBP principles in clinical decision-making. The objectives for this project were to pilot an international web-based survey of chiropractic students and to describe student attitudes, behaviors, and knowledge about EBP principles. METHODS We used SurveyMonkey™ to develop our survey based on an existing questionnaire used to measure basic knowledge, skills and beliefs about EBP among allied healthcare professionals and CAM practitioners. We invited 26 chiropractic educational institutions teaching in English and accredited by official organizations to participate. Academic officials and registrars at participating institutions forwarded an invitation email and two reminders to students between July and September 2010. The invitation contained a link to the 38-item web-based questionnaire. Descriptive statistics were performed for analysis. RESULTS Fourteen institutions from Australia, Canada, US, Denmark and New Zealand participated. Among an estimated 7,142 student recipients of invitation letters, 674 participated in the survey for an estimated response rate of 9.4%. Most respondents reported having access to medical/healthcare literature through the internet, but only 11% read literature every week and 21% did not read literature at all. Respondents generally agreed that the use of research evidence in chiropractic was important. Although 76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care. Respondents without previous training in research methods had lower confidence in assessing published papers. While more than 60% marked the correct answer for two knowledge items, the mean number of correct answers to the five knowledge questions was 1.3 (SD 0.9). CONCLUSIONS Although it is feasible to conduct an international web survey of chiropractic students, significant stakeholder participation is important to improve response rates. Students had relatively positive attitudes toward EBP. However, participants felt they needed more training in EBP and based on the knowledge questions they may need further training about basic research concepts.
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Affiliation(s)
- Ryunosuke Banzai
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803-5209, USA
| | - Dustin C Derby
- Institutional Planning & Research, Palmer College of Chiropractic, 723 Brady Street, Davenport, IA 52803-5209, USA
| | - Cynthia R Long
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803-5209, USA
| | - Maria A Hondras
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, 741 Brady Street, Davenport, IA 52803-5209, USA
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Goff SL, Holboe ES, Concato J. Pediatricians and physical activity counseling: how does residency prepare them for this task? TEACHING AND LEARNING IN MEDICINE 2010; 22:107-111. [PMID: 20614375 DOI: 10.1080/10401331003656512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Physical activity (PA) health benefits are clear, yet few children in the United States achieve recommended PA levels. Pediatricians provide PA counseling, but it is not known how residencies prepare trainees for this task. The objective was to determine current training methods for PA counseling in pediatric residency programs. SUMMARY Web-based questionnaire exploring curricular content, barriers to curriculum development, and attitudes/beliefs about the pediatrician's role regarding PA counseling was sent to 192 U.S. pediatric residency directors. There were 115 of 192 (60%) programs that responded. Curricula focused on knowledge-based topics with limited training in counseling skills. Respondents felt PA counseling was important, but few felt they could influence PA. Perceived barriers to curriculum development included lack of space in the curriculum, few trained faculty, and insufficient educational materials. CONCLUSIONS Curricula that include a skills-based component in addition to knowledge attainment may improve pediatricians' PA counseling skills.
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Affiliation(s)
- Sarah L Goff
- Department of Pediatrics, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
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Didwania A, McGaghie WC, Cohen E, Wayne DB. Internal medicine residency graduates' perceptions of the systems-based practice and practice-based learning and improvement competencies. TEACHING AND LEARNING IN MEDICINE 2010; 22:33-36. [PMID: 20391281 DOI: 10.1080/10401330903446305] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Resident education in Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) is required but underemphasized. PURPOSES The objectives are to identify SBP and PBLI knowledge and skills with the most relevance to our graduates' practices and to determine how well they were prepared during residency training to address these issues. METHODS A survey was drafted based on Accreditation Council for Graduate Medical Education competency definitions and published literature on SBP and PBLI. Respondents indicated the extent to which each item is relevant to their practice and the adequacy of instruction received on a 5-point Likert scale. RESULTS All topics had high perceived relevance to practice with most topics rated low for adequacy of training. Topics of practice management and health care economics contained the largest gaps between mean ratings of relevance and adequacy of training (p < .001). Few differences in ratings were seen based on graduate demographics. CONCLUSIONS This survey has allowed us to prioritize SBP and PBLI curricula to meet the needs of our graduates.
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Affiliation(s)
- Aashish Didwania
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Wyer PC, Naqvi Z, Dayan PS, Celentano JJ, Eskin B, Graham MJ. Do workshops in evidence-based practice equip participants to identify and answer questions requiring consideration of clinical research? A diagnostic skill assessment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2009; 14:515-533. [PMID: 18766450 DOI: 10.1007/s10459-008-9135-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 08/05/2008] [Indexed: 05/26/2023]
Abstract
Evidence-based practice (EBP) requires practitioners to identify and formulate questions in response to patient encounters, and to seek, select, and appraise applicable clinical research. A standardized workshop format serves as the model for training of medical educators in these skills. We developed an evaluation exercise to assess the ability to identify and solve a problem requiring the use of targeted skills and administered it to 47 North American junior faculty and residents in various specialties at the close of two short workshops in EBP. Prior to the workshop, subjects reported prior training in EBP and completed a previously validated knowledge test. Our post-workshop exercise differed from the baseline measures and required participants to spontaneously identify a suitable question in response to a simulated clinical encounter, followed by a description of a stepwise approach to answering it. They then responded to successively more explicitly prompted queries relevant to their question. We analyzed responses to identify areas of skill deficiency and potential reasons for these deficiencies. Twelve respondents (26%) initially failed to identify a suitable question in response to the clinical scenario. Ability to choose a suitable question correlated with the ability to connect an original question to an appropriate study design. Prior EBP training correlated with the pretest score but not with performance on our exercise. Overall performance correlated with ability to correctly classify their questions as pertaining to therapy, diagnosis, prognosis, or harm. We conclude that faculty and residents completing standard workshops in EBP may still lack the ability to initiate and investigate original clinical inquiries using EBP skills.
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Affiliation(s)
- Peter C Wyer
- Department of Medicine, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
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Ilic D. Teaching Evidence-based Practice: Perspectives from the Undergraduate and Post-graduate Viewpoint. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n6p559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Introduction: Evidence-based practice (EBP) involves making clinical decisions informed by the most relevant and valid evidence available. It has been suggested that the outcomes of teaching EBP skills may differ between undergraduates and post-graduates due to different determinants in learning. This paper reviews the current literature and discusses the impact of the teaching environment (undergraduate or post-graduate) for teaching EBP and its impact on EBP competency.
Methods: A search of the literature was performed across the MEDLINE, CINAHL, PsychInfo and ERIC databases. Randomised controlled trials (RCTs) and non-randomised trials were eligible for inclusion in the paper. Studies were included for review if they explored the impact of teaching on participants’ EBP competency, consisting of critical appraisal skills, knowledge and/or behaviour.
Results: Ten articles were eligible for inclusion for this review, of which 7 met all inclusion criteria. EBP competency was shown to increase regardless of whether EBP is delivered to medical students at an undergraduate or post-graduate level. EBP taught to a non-medical undergraduate audience did not modify participants’ EBP competency. No study directly compared teaching EBP to an undergraduate and post-graduate audience.
Conclusions: Given the limited amount of studies included in this review, further research incorporating high- level methodologies is required to establish a clear recommendation on the research question.
Key words: Competency-based education, Evidence-based practice, Graduate medical educa- tion, Undergraduate medical education
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Affiliation(s)
- Dragan Ilic
- Monash University, Clayton VIC 3168, Australia
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Teo AR. The development of clinical research training: past history and current trends in the United States. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:433-438. [PMID: 19318772 DOI: 10.1097/acm.0b013e31819a81c9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article provides a brief account of the history of the development of training opportunities in clinical research in the United States. It highlights some developments in the clinical research enterprise since World War II and focuses examination on the involvement of the U.S. government and academic sector. Clinical research training is a relatively new academic field, and curricula in the design and conduct of clinical research have only emerged since the 1980s. The growing complexity of clinical trials and the emergence of evidence-based medicine in the last several decades created great demand for clinicians with knowledge of clinical epidemiology and biostatistics. Amidst alarm bells rung by physician-scientist leaders about the endangered species of clinical researchers, numerous proposals and solutions emerged to address these workforce and educational problems in the 1990s. Traditionally, physicians wishing to expand their education had to get a master's degree in public health or participate in unique programs such as the Robert Wood Johnson Clinical Scholars Program. Since the 1990s, the National Institutes of Health, through K awards, the Roadmap Initiative, and other funding mechanisms, has furnished tremendous support for the development of clinical research training opportunities from predoctoral immersion programs to degree-granting graduate programs. The author discusses key components of successful clinical research training programs and concludes with empirical recommendations for promoting careers in clinical research.
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Affiliation(s)
- Alan R Teo
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA.
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Dahm P, Preminger GM, Scales CD, Fesperman SF, Yeung LL, Cohen MS. Evidence-based medicine training in residency: a survey of urology programme directors. BJU Int 2009; 103:290-3. [PMID: 19187354 DOI: 10.1111/j.1464-410x.2008.08326.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether and in what format urology residents receive formal training in evidence-based clinical practice. METHODS In 2007 we conducted a survey of the Accreditation Council for Graduate Medical Education (ACGME)-accredited urology residency programmes in the USA. The survey instrument was sent to all programmes, using postal mailing, e-mail and a web-based interface. Programme director and coordinator names and basic demographic information such as programme size and length were retrieved from the institutions' websites and the ACGME database. RESULTS Of 117 ACGME-accredited urology programmes, 108 responded (92.3%). Most respondents either agreed or strongly agreed with statements that formal evidence-based medicine (EBM) training was valuable to urology residents (97, 89.8%) and should be part of all residency programme curricula (91, 84.3%). Eighty-four programmes (77.8%) indicated that their curricula included formal educational activities related to EBM. These programmes provided a median (interquartile range) of 10 (4.8-25.0) h of EBM teaching per academic year. Most programmes (65.9%) provided fewer hours of EBM training than programme directors perceived as ideal. Asked what would make it easier to integrate EBM into the programme, respondents identified urology-specific educational materials (33.3%), a formal curriculum (24.4%) and faculty development (16.3%) as central needs. CONCLUSION In this survey we found that most programme directors recognize formal EBM teaching as an important aspect of urology residency training. However, most programmes devote less time to EBM training than they would like, and urology-specific resources have been lacking. These findings support increased efforts to provide urology residents with opportunities to learn EBM-related knowledge and skills in a variety of educational formats.
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Affiliation(s)
- Philipp Dahm
- Department of Urology, University of Florida, College of Medicine, Gainesville, FL 32610-0247, USA.
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Kim S, Willett LR, Murphy DJ, O'Rourke K, Sharma R, Shea JA. Impact of an evidence-based medicine curriculum on resident use of electronic resources: a randomized controlled study. J Gen Intern Med 2008; 23:1804-8. [PMID: 18769979 PMCID: PMC2585665 DOI: 10.1007/s11606-008-0766-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 07/24/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence-based medicine (EBM) is widely taught in residency, but evidence for effectiveness of EBM teaching on changing residents' behavior is limited. OBJECTIVE To investigate the impact of an EBM curriculum on residents' use of evidence-based resources in a simulated clinical experience. DESIGN/PARTICIPANTS Fifty medicine residents randomized to an EBM teaching or control group. MEASUREMENTS A validated test of EBM knowledge (Fresno test) was administered before and after intervention. Post intervention, residents twice completed a Web-based, multiple-choice instrument (15 items) comprised of clinical vignettes, first without then with access to electronic resources. Use of electronic resources was tracked using ProxyPlus software. Within group pre-post differences and between group post-test differences were examined. RESULTS There was more improvement in EBM knowledge (100-point scale) for the intervention group compared to the control group (mean score increase 22 vs. 12, p = 0.012). In the simulated clinical experience, the most commonly accessed resources were Ovid (71% of residents accessed) and InfoPOEMs (62%) for the EBM group and UptoDate (67%) and MDConsult (58%) for the control group. Residents in the EBM group were more likely to use evidence-based resources than the control group. Performance on clinical vignettes was similar between the groups both at baseline (p = 0.19) and with access to information resources (p = 0.89). CONCLUSIONS EBM teaching improved EBM knowledge and increased use of evidence-based resources by residents, but did not improve performance on Web-based clinical vignettes. Future studies will need to examine impact of EBM teaching on clinical outcomes.
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Affiliation(s)
- Sarang Kim
- University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
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Allan GM, Korownyk C, Tan A, Hindle H, Kung L, Manca D. Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:581-7. [PMID: 18520465 DOI: 10.1097/acm.0b013e3181723a5c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.
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Affiliation(s)
- G Michael Allan
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
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Moskowitz EJ, Nash DB. Accreditation Council for Graduate Medical Education competencies: practice-based learning and systems-based practice. Am J Med Qual 2007; 22:351-82. [PMID: 17804395 DOI: 10.1177/1062860607305381] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eric J Moskowitz
- Department of Health Policy, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA
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Burneo JG, Jenkins ME, Bussière M. Evaluating a formal evidence-based clinical practice curriculum in a neurology residency program. J Neurol Sci 2006; 250:10-9. [PMID: 16859711 DOI: 10.1016/j.jns.2006.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 06/02/2006] [Accepted: 06/08/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Since 1998, the University of Western Ontario Evidence-Based Neurology Programme has been fostering life-long self-teaching, self-evaluation, and promoting improvement of the care of neurological patients by teaching neurology residents to practice Evidence-Based Clinical Practice (EBCP). DESIGN/METHODS Using a questionnaire/survey we evaluated participation during EBCP sessions and the applicability of EBCP to current and future clinical practice. Also, using a rating scale we investigated how likely our residents' and graduates' clinical practice has been influenced by the EBCP knowledge; and, if they were teaching these concepts to residents or medical students. The questionnaire was sent to all neurology residents and neurologists that graduated after implementation of the programme. RESULTS All residents (100%) returned the survey/questionnaire, indicating that they attended the sessions consistently. Even though all respondents believed that the EBCP concepts were useful during their training, the concepts were infrequently utilized because of time constraints. On a scale of 1 to 10, they rated the influence to include EBCP concepts in their daily clinical practice as high (average: 6.8, S.D. 1.5). They all had frequent contact with medical students and non-neurology residents, but did not teach EBCP concepts to them on a consistent basis, because of time limitations. 10 (77%) out of 13 graduates returned the survey/questionnaire. They also believed the EBCP concepts were useful, but only used them when time allowed. They also rated the influence to include EBCP concepts in their daily clinical practice as high (mean 8.5, S.D. 1.2). Most graduates had frequent contact with trainees, but did not teach EBCP concepts to them on a consistent basis because of time constraints. Finally, all expressed the need to continue having this formal curriculum during residency. CONCLUSION/RELEVANCE Although EBCP incorporated into the curriculum of a neurology residency programme increased neurologists and neurology trainees' confidence in knowledge of existing evidence, and reinforced the EBCP principles, these concepts were not used in daily clinical practice and were not taught to more junior trainees due to time constraints.
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Affiliation(s)
- J G Burneo
- Department of Clinical Neurological Sciences, University of Western Ontario, Canada.
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Patel MR, Schardt CM, Sanders LL, Keitz SA. Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol. J Med Libr Assoc 2006; 94:382-7. [PMID: 17082828 PMCID: PMC1629432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVE The paper compares the speed, validity, and applicability of two different protocols for searching the primary medical literature. DESIGN A randomized trial involving medicine residents was performed. SETTING An inpatient general medicine rotation was used. PARTICIPANTS Thirty-two internal medicine residents were block randomized into four groups of eight. MAIN OUTCOME MEASURES Success rate of each search protocol was measured by perceived search time, number of questions answered, and proportion of articles that were applicable and valid. RESULTS Residents randomized to the MEDLINE-first (protocol A) group searched 120 questions, and residents randomized to the MEDLINE-last (protocol B) searched 133 questions. In protocol A, 104 answers (86.7%) and, in protocol B, 117 answers (88%) were found to clinical questions. In protocol A, residents reported that 26 (25.2%) of the answers were obtained quickly or rated as "fast" (<5 minutes) as opposed to 55 (51.9%) in protocol B, (P = 0.0004). A subset of questions and articles (n = 79) were reviewed by faculty who found that both protocols identified similar numbers of answer articles that addressed the questions and were felt to be valid using critical appraisal criteria. CONCLUSION For resident-generated clinical questions, both protocols produced a similarly high percentage of applicable and valid articles. The MEDLINE-last search protocol was perceived to be faster. However, in the MEDLINE-last protocol, a significant portion of questions (23%) still required searching MEDLINE to find an answer.
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Affiliation(s)
| | | | | | - Sheri A. Keitz
- Department of Medicine, Duke University Medical Center and Durham VAMC, Durham, North Carolina
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Abstract
Evidence-based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non-evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient.
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Affiliation(s)
- Mark R Tonelli
- Division of Pulmonary and Critical Care Medicine, Department of Medicine and, Department of Medical History and Ethics, University of Washington, Seattle, WA 98195-6522, USA.
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Hatala R, Keitz SA, Wilson MC, Guyatt G. Beyond journal clubs. Moving toward an integrated evidence-based medicine curriculum. J Gen Intern Med 2006; 21:538-41. [PMID: 16704406 PMCID: PMC1484798 DOI: 10.1111/j.1525-1497.2006.00445.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Incorporating evidence-based medicine (EBM) into clinical practice is an important competency that residency training must address. Residency program directors, and the clinical educators who work with them, should develop curricula to enhance residents' capacity for independent evidence-based practice. In this article, the authors argue that residency programs must move beyond journal club formats to promote the practice of EBM by trainees. The authors highlight the limitations of journal club, and suggest additional curricular approaches for an integrated EBM curriculum. Helping residents become effective evidence users will require a sustained effort on the part of residents, faculty, and their educational institutions.
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Affiliation(s)
- Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Meyring S, Leopold HC, Siebolds M. Einführung eines kompetenzbasierten Facharztweiterbildungsprogramms in einer neurologischen Abteilung. DER NERVENARZT 2006; 77:439-48. [PMID: 16341733 DOI: 10.1007/s00115-005-2026-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Competency-based programs have long been the basis of graduate medical education in British and North America. Such formally defined program structures are lacking in German graduate medical education. METHODS The methods and assessment tools used in a curriculum-based program of graduate education in medical specialties are presented. The feasibility of the program was tested in day-to-day use in a pilot study conducted within a neurology department. Experience of it during a 1-year period after implementation has also been collected. RESULTS It was found that implementation of the program is feasible providing that both the trainers and the students are well motivated, that adequate resources are provided, and that a formal training system is provided for the trainers. This is confirmed by the 1-year experience of the program in routine clinical practice. CONCLUSIONS The competency-based program presented, which is compatible with many quality management systems, offers management and assessment tools that will make for more satisfactory postgraduate medical education.
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Schwartz A, Millam G. A web-based library consult service for evidence-based medicine: Technical development. BMC Med Inform Decis Mak 2006; 6:16. [PMID: 16542453 PMCID: PMC1484475 DOI: 10.1186/1472-6947-6-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 03/16/2006] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. RESULTS To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. CONCLUSION A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement.
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Affiliation(s)
- Alan Schwartz
- Department of Medical Education, University of Illinois at Chicago, Chicago, USA
- Department of Pediatrics, University of Illinois at Chicago, Chicago, USA
| | - Gregory Millam
- Department of Medical Education, University of Illinois at Chicago, Chicago, USA
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Dinkevich E, Markinson A, Ahsan S, Lawrence B. Effect of a brief intervention on evidence-based medicine skills of pediatric residents. BMC MEDICAL EDUCATION 2006; 6:1. [PMID: 16403214 PMCID: PMC1368975 DOI: 10.1186/1472-6920-6-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 01/10/2006] [Indexed: 05/06/2023]
Abstract
BACKGROUND While Evidence-Based Medicine (EBM) skills are increasingly being taught in medical schools, teaching quality has been insufficient, so that incoming pediatric residents lack adequate EBM skills required for patient care. The objective of this study was to evaluate the effectiveness of a brief teaching module developed to improve EBM skills of pediatric residents. METHODS With-in subjects study design with pre- and post-test evaluation was performed in a large urban pediatric residency training program in Brooklyn, New York. We included PGY-1s during intern orientation, while second and third year pediatric residents were selected based on schedule availability. Sixty-nine residents were enrolled into the study, 60 (87%) completed the training. An EBM training module consisting of three or four weekly two-hour seminars was conducted. The module was designed to teach core EBM skills including (1) formulating answerable clinical questions, (2) searching the evidence, (3) critical appraisal skills including validity and applicability, and (4) understanding levels of evidence and quantitative results for therapy articles. A portion of the Fresno test of competence in EBM was used to assess EBM skills. The test presented a clinical scenario that was followed by nine short answer questions. One to three questions were used to assess EBM skills for each of the four core skills. The kappa co-efficient for inter-rater reliability was 0.74 (95% CI: 0.56-0.92). RESULTS Prior to the training module, the residents achieved a mean score of 17% correct overall. Post intervention, the mean score increased to 63% with improvement in each EBM category. A mean of 4.08 more questions (out of 9) were answered correctly after the training (95% CI of 3.44-4.72). CONCLUSION A brief training module was effective in improving EBM skills of pediatric residents.
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Affiliation(s)
- Eugene Dinkevich
- Department of Pediatrics, SUNY-Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Andrea Markinson
- Institute for Evidence-Based Practice, Medical Research Library of Brooklyn, SUNY-Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Sama Ahsan
- SUNY-Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Barbara Lawrence
- SUNY-Downstate College of Medicine, 450 Clarkson Avenue, Brooklyn, NY, USA
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Abstract
This longitudinal follow-up study surveyed the attitudes toward, and skills in, evidence-based medicine (EBM) of medical school graduates who had participated in a formal EBM curriculum during their third-year Internal Medicine (IM) clerkship. The objective was to measure whether competencies were retained over time and to identify the long- term impact on the graduates' attitudes toward, and proficiency in, EBM after graduation. Questionnaire results showed that a group of medical school graduates retained EBM skills and a positive attitude about the importance of applying EBM principles in patient care one to three years after completing an EBM course.
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Affiliation(s)
- Josephine Dorsch
- Library of the Health Sciences-Peoria, University of Illinois at Chicago, Peoria, IL 61656, USA.
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Frohna JG, Gruppen LD, Fliegel JE, Mangrulkar RS. Development of an evaluation of medical student competence in evidence-based medicine using a computer-based OSCE station. TEACHING AND LEARNING IN MEDICINE 2006; 18:267-72. [PMID: 16776616 DOI: 10.1207/s15328015tlm1803_13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Instruction in evidence-based medicine (EBM) has been widely incorporated into medical school curricula with little evidence of its effectiveness. Our goal was to create, implement, and validate a computer-based assessment tool that measured medical students' EBM skills. DESCRIPTION As part of a required objective structured clinical examination, we developed a specific case scenario in which students (a) asked a structured clinical question using a standard framework, (b) generated effective MEDLINE search terms to answer a specific question, and (c) elected the most appropriate of 3 abstracts generated from a search justifying which best applies to the patient scenario. EVALUATION Between the 3 blinded raters, there was very good interrater reliability with 84, 94, and 96% agreement on the scoring for each component, respectively (k = .64, .82, and .91, respectively). In addition, students found the station appropriately difficult for their level of training. CONCLUSIONS This computer-based tool appears to measure several EBM skills independently and combines simple administration and scoring. Its generalizability to other cases and settings requires further study.
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Affiliation(s)
- John G Frohna
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan 48109-0368, USA.
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Holmboe ES, Bowen JL, Green M, Gregg J, DiFrancesco L, Reynolds E, Alguire P, Battinelli D, Lucey C, Duffy D. Reforming internal medicine residency training. A report from the Society of General Internal Medicine's task force for residency reform. J Gen Intern Med 2005; 20:1165-72. [PMID: 16423110 PMCID: PMC1490285 DOI: 10.1111/j.1525-1497.2005.0249.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Revised: 07/26/2005] [Accepted: 07/26/2005] [Indexed: 11/26/2022]
Affiliation(s)
- Eric S Holmboe
- American Board of Internal Medicine, Philadelphia, PA 19106, USA.
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Kersten HB, Randis TM, Giardino AP. Evidence-Based Medicine in Pediatric Residency Programs: Where Are We Now? ACTA ACUST UNITED AC 2005; 5:302-5. [PMID: 16167855 DOI: 10.1367/a04-182r1.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Evidence-based medicine (EBM) integrates the best research evidence with clinical expertise and patient values to optimize clinical outcomes for our patients. OBJECTIVE To examine incorporation of EBM into journal club (JC) and other venues within pediatric residency programs. DESIGN/METHODS A 30-question confidential survey was designed to determine how residents are taught and practice EBM. The survey was sent to the chief resident (CR) at all North American pediatric residency programs (N = 192). Nonrespondents were sent surveys 4 and 8 weeks later. RESULTS The response rate was 80% (n = 153). Pediatric residency programs varied in size from 12 to 132 residents from responses in 39 states. Most programs (97%, confidence interval [CI], 92-99) used EBM. JC (89%, CI, 83-93), noontime lectures (62%, CI, 54-70), and morning report (61%, CI, 53-69) were the most common venues used to teach EBM. JC (58%, CI, 50-66), morning report (11%, CI, 6-17), and resident workshop (11%, CI, 6-17) were the most effective venues to teach EBM, although resident workshops were as effective as JC to teach EBM in programs offering workshops (38% each, CI, 21-56). Most CRs felt confident in their ability to practice EBM (56%, CI, 48-64), but few CRs felt that their program could teach EBM (7%) or evaluate EBM effectiveness (20%). CONCLUSIONS EBM is common throughout pediatric residencies. JC was the most effective venue in which to teach EBM, unless a workshop was offered. Most CRs thought it was important to teach EBM, but did not feel confident in their program's ability to teach EBM.
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Affiliation(s)
- Hans B Kersten
- Department of Pediatrics (Dr Kersten), Drexel University College of Medicine, Section of General Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA 19134, USA.
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Kuhn GJ, Wyer PC, Cordell WH, Rowe BH. A survey to determine the prevalence and characteristics of training in Evidence-Based Medicine in emergency medicine residency programs. J Emerg Med 2005; 28:353-359. [PMID: 15769588 DOI: 10.1016/j.jemermed.2004.09.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2003] [Revised: 07/28/2004] [Accepted: 09/23/2004] [Indexed: 11/22/2022]
Abstract
We conducted a survey to determine the prevalence, training methods, and allotment of time for teaching evidence-based medicine (EBM) skills within accredited Emergency Medicine (EM) residency programs in the United States. A survey was mailed to program directors of all 122 accredited Emergency Medicine residency programs. The survey was also sent to program directors using an e-mail listserv. Responses were obtained from 53% of programs; 80% (95% CI: 68-89) of EM programs reported teaching some EBM. Although respondents believed a median of 10 hours were required to adequately cover this topic, only 22% provided more than 5 hours per year. Sixtey-three percent (95% CI: 50-75) of respondents reported using the JAMA Users' Guides series in journal club and 83% reported efforts to link journal clubs to patient care. Perceived barriers to integrating EBM into teaching and patient care included lack of trained faculty, lack of time, lack of familiarity with EBM resources, insufficient funding, and lack of interested faculty. In summary, academic EM programs are attempting to train residents in EBM, but perceive a lack of trained faculty, time, and funding as barriers. Desired resources include a defined curriculum, on-line training for faculty, and defined strategies for integration of EBM into training and patient care.
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Affiliation(s)
- Gloria J Kuhn
- Department of Emergency Medicine, Detroit Receiving Hospital, University Health Center, Wayne State University, Detroit, Michigan
| | - Peter C Wyer
- Department of Emergency Medicine, New York Presbyterian Hospital, New York, New York
| | - William H Cordell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian H Rowe
- Division of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
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Nicholson LJ, Shieh LY. Teaching evidence-based medicine on a busy hospitalist service: residents rate a pilot curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:607-9. [PMID: 15917368 DOI: 10.1097/00001888-200506000-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE To increase evidence-based medicine (EBM) instruction within the confines of reduced resident work hours. METHOD In 2001-02, the authors designed and implemented an EBM curriculum for residents on an inpatient medicine service at Stanford University Medical Center. Thirty-six residents were assigned the hospitalist rotation in its pilot year. Attendings introduced EBM concepts and Internet resources. During daily rounds, housestaff presented patient-based EBM literature search results. After the rotation, residents were given a questionnaire on which they were asked to rate the impact of the curriculum on their understanding of 20 EBM terms or practice skills (1 = no effect to 5 = strong effect). RESULTS Twenty-three residents (64%) completed the questionnaire. The results were very positive with average effect of more than 4 (somewhat strong effect/impact) for 16 of the 20 questions. High-speed Internet access and EBM Web resources were critical to efficient delivery of the curriculum during inpatient care. CONCLUSION The pilot curriculum successfully introduced the practice of EBM during active inpatient care without requiring additional hours from housestaff schedules. To further evaluate and expand this project, EBM skills will be tested before and after the rotation, and faculty development will allow consistent delivery in additional clinical settings.
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