Individual and organizational factors associated with evidence-based practice among physical and occupational therapy recent graduates: A cross-sectional national study

Exploring the Impact of Self-Leadership on Evidence-Based Practice Beliefs Among Physical Therapists and Doctor of Physical Therapy Students

INTRODUCTION

This study explored the self-leadership and evidence-based practice (EBP) beliefs among Doctor of Physical Therapy (DPT) students and licensed physical therapists (PTs).

REVIEW OF THE LITERATURE

Evidence-based practice offers health care professionals a systematic approach to applying research to improve patient outcomes. Despite positive attitudes toward EBP, PTs often struggle to translate scientific knowledge into clinical practice. While many frameworks emphasize the importance of organizational leadership in EBP, self-leadership, directing oneself toward personal goals, remains underexplored.

SUBJECTS

The study included 860 participants: 158 DPT students, 235 early-career PTs with less than 10 years of clinical experience, and 467 late-career PTs with 10 or more years of experience.

METHODS

A cross-sectional online survey explored the relationship and group differences between Revised Self-Leadership Questionnaire scores and Evidence-Based Practice (EBP) Beliefs Scale scores among physical therapists and DPT students. The statistical analysis approaches included Spearman's Rank Correlations, Kruskal-Wallis H tests, and multiple stepwise regressions.

RESULTS

Weak correlations existed between self-leadership and EBP beliefs in DPT students and late-career PTs, while a moderate correlation was observed in early-career PTs. Although self-leadership and EBP beliefs varied between groups, the differences were minor. Intrinsic DPT student and physical therapist characteristics showed minimal predictive value for EBP beliefs, highlighting the continued complexity of understanding EBP beliefs and implementation within the physical therapy profession.

DISCUSSION AND CONCLUSION

A persistent gap exists in understanding the clinician-specific factors influencing EBP beliefs in physical therapy. These findings emphasize the need to identify and cultivate factors positively affecting EBP adoption and self-leadership among physical therapists and students. Future research should look to understand the complex interplay between personal attributes and organizational dynamics to enhance EBP implementation in clinical practice.

Perspectives on how evidence-based practice changes over time: A qualitative exploration of occupational therapy and physical therapy graduates

RATIONALE

The integration of evidence-based practice (EBP) into rehabilitation education programs has been widespread, but little is known about how graduates' EBP competencies evolve over time.

AIMS AND OBJECTIVES

To explore how and why the use of EBP by occupational therapists (OTs) and physical therapists (PTs) evolves during the first 3 years of clinical practice.

METHOD

We used an interpretive description methodology. We conducted semi-structured interviews with OTs and PTs who participated in a minimum of three out of four time points in a previous longitudinal pan-Canadian mixed methods study. Data analysis was guided by Braun and Clarke's approach to thematic analysis.

RESULTS

Seventeen clinicians (13 OTs and 4 PTs) participated in the study. Our analysis identified six overarching themes: (1) evolution of "what EBP is and what it means"; (2) over time, evidence takes a back seat; (3) patients and colleagues have a vital and perennial role in clinical decision making; (4) continuing professional development plays a vital role in EBP; (5) personal attitudes and attributes influence EBP; and (6) organizational factors influence EBP.

CONCLUSION

Our study highlights the dynamic nature of EBP use among OTs and PTs in the first 3 years of clinical practice, emphasizing the need for contextualized approaches and ongoing support to promote evidence-informed healthcare in rehabilitation.

Deployment of professional expertise during a period of disruption: A phenomenological study of rehabilitation clinicians

RATIONALE

Practice context is known to influence the deployment of competencies. The COVID-19 pandemic created a major disruption in many practice contexts. The objective was to understand the lived experience of rehabilitation clinicians during a major disruption of their practice context, namely, the COVID-19 pandemic.

METHODS

We used a longitudinal phenomenological design. Eligible clinicians were occupational therapists (OT), physical therapists (PT), physiotherapy technologists (Phys T.), speech-language pathologists (S-LP) and audiologists (AUD), working in the same rehabilitation workplace for at least 2 years before March 2020 (the pandemic). Clinicians who were reassigned to roles outside the field of rehabilitation were excluded. We conducted individual online interviews using a guide developed by the team with expertise and knowledge of the phenomenon. An interpretative phenomenological analysis was carried out. Results were discussed until the research team reached a consensus.

RESULTS

A total of 32 clinicians participated in the study (12 OT, 5 PT, 5 Phys T., 7 S-LP, 3 AUD), working with a variety of clienteles and work settings, for an average of 11.7 ± 7.6 years in the same practice setting. A wide range of emotions (e.g. anger, sadness, guilt, fear, pride) reflected clinicians' experience during disruption. Professional expertise was perceived as being enhanced by disruption as clinicians stepped out of their comfort zone; this encouraged reflective practice and a recognition of the need to be more explicit about their decision-making process. Collaboration with colleagues was perceived as key for effective coping and deployment of adaptative expertise.

CONCLUSIONS

A disruption in the practice context may have positive effects on professional expertise through the mobilization of reflective practice.

Implementation and sustainment of a clinical practice guideline in a physical therapy student-run pro bono clinic: a case report

BACKGROUND

The development of evidence-based practitioners is an expectation of entry-level physical therapist education. Knowledge translation is a process to enhance the uptake of evidence into clinical practice. Student run pro bono clinics provide an authentic learning environment in which knowledge translation activities can be used to implement clinical practice guidelines (CPGs).

PURPOSE

The purpose of this case report was to describe the implementation, evaluation, and sustainment process of incorporating a physical therapy neurologic outcome measure CPG in a physical therapy student run pro bono clinic.

METHODS

A mixed methods study, using the Knowledge to Action framework, was completed to standardize the outcome measures completed on patients with neurologic conditions who received services at a physical therapy student run pro bono clinic. The project was titled iKNOW (integrating KNOWledge translation) Super Six.

RESULTS

Chart audits, surveys, and focus groups revealed success in implementing a CPG promoting standardization of practice in a student run pro bono clinic. Students reported that environmental modifications and the availability of resources were strong facilitators of completing the measures. Differences existed between cohorts in perceived usefulness of peer support. To sustain use of the neurologic outcome measures as recommended by the CPG, efforts to enhance awareness, leverage peer support, maximize environmental facilitators, along with audit and feedback will continue.

CONCLUSION

Student run pro bono clinics provide the environment for the implementation of CPGs. Students engaging in knowledge translation may develop the skills needed as an evidence-based practitioner.

Perspectives of paediatric occupational therapists on the use of evidence-based practice in Kuwait: a qualitative study

OBJECTIVES

To investigate the perspectives of paediatric occupational therapists on factors relating to the use of evidence-based practice (EBP) in clinical practice/settings.

DESIGN

A qualitative approach entailing the use of (face-to-face) semistructured interviews. Collected data were analysed using thematic analysis.

SETTING

Governmental and private hospitals, clinics and schools in Kuwait that offered occupational therapy services.

PARTICIPANTS

10 occupational therapists with a minimum of 2 years experience working with children.

PRIMARY AND SECONDARY OUTCOME MEASURES

Occupational therapists' perspectives on the factors relating to the implementation of EBP in clinical practice.

RESULTS

Three themes emerged: (1) source of motivation towards EBP; (2) organisational support for EBP use and (3) creativity and flexibility in implementing EBP. Several motivators encouraged therapists to use EBP in their clinical practice, including their personal motivation and clients' outcomes. However, the barriers to EBP implementation are due to the lack of organisational support for EBP. Using creativity and flexibility in practice is essential to overcome challenges.

CONCLUSION

This study identified factors related to the implementation of EBP from the perspective of paediatric occupational therapists in Kuwait. It provides several implications and recommendations for occupational therapy education and practice in the region due to similarities in culture. As therapists' concerns are identified, developing the educational curricula at universities and providing continuous professional development courses in regard to EBP utilisation are important for delivering effective healthcare services.

Translation, cross-cultural adaptation, and validation of the Spanish Evidence-Based Practice Confidence (EPIC) scale in occupational therapy students and professionals

BACKGROUND

Assessing self-efficacy in evidence-based practice (EBP) is crucial for identifying training needs, evaluating the effectiveness of educational programs, and assessing the overall application confidence of EBP in healthcare professions, including occupational therapy (OT). Thus, the objectives of this study were to cross-culturally adapt the Evidence-Based Practice Confidence Scale (EPIC) for Spanish-speaking OT students and professionals and to evaluate its internal consistency, test-retest reliability, and construct validity.

METHODS

A professional translation and cross-cultural adaptation of the EPIC was developed, including a pilot study that resulted in the EPIC Spanish version. A total of 260 OT students and 202 professionals completed the Spanish EPIC at baseline, with 177 (68.1%) students and 129 (63.9%) professionals participating in the test-retest reliability assessment two weeks later. The EPIC's internal consistency was evaluated using Cronbach's alpha. Test-retest reliability was assessed using Spearman's correlations and intra-class correlations (ICC). Known-groups validity hypothesis based on participants' roles (students, diploma/bachelor's, master's, and doctorate) was explored using ANOVA. Finally, an exploratory factor analysis with oblique Promax rotation was conducted to examine the EPIC factor structure.

RESULTS

Cronbach's alpha for the total EPIC score was excellent in both OT professionals (α = 0.91) and students (α = 0.90). For OT students, Spearman's correlation was 0.67 (p < 0.001) for the total score, and the ICC was 0.66 (95%CI 0.57-0.73). Conversely, for OT professionals, test-retest reliability showed a Spearman's correlation of 0.87 (p < 0.001) for the total score, and the ICC was 0.87 (95%CI 0.81-0.90). The highest scores were observed in professionals with a doctorate followed by those with a master's degree (p < 0.001). The exploratory factor analysis yielded a 3-factor solution that explained 71% of the observed variance, with item-level loadings ≥ 0.35.

CONCLUSIONS

The EPIC scale showed excellent internal consistency, strong test-retest reliability, and adequate construct validity for evaluating EBP self-efficacy among Spanish-speaking OT professionals using the total score. However, test-retest reliability was moderate among Spanish-speaking OT students, indicating that changes in EBP confidence assessed with the EPIC scale in this group should be interpreted with caution.

Stakeholders' priorities in the development of evidence-based practice competencies in rehabilitation students: a nominal group technique study

PURPOSE

Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP).

MATERIALS AND METHODS

Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8).

RESULTS

The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings.

CONCLUSION

Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies.

Developing multisectoral strategies to promote evidence-based practice in rehabilitation: findings from an end-of-grant knowledge translation symposium

PURPOSE

Following a longitudinal study to understand how evidence-based practice evolves during the initial years of occupational therapy (OT) and physiotherapy (PT) practice, we held an end-of-grant symposium with representatives from education, practice, research, and policy. The objectives were to: (1) elicit feedback on the implications of the study results; and (2) co-develop a list of actionable recommendations for each sector.

METHODS

Qualitative participatory approach. The symposium was held over two half days and consisted of a presentation of study findings, a discussion on the implications of the research for each sector and future recommendations. Discussions were audio recorded, transcribed verbatim and analyzed using qualitative thematic analysis.

RESULTS

The themes related to implications of the longitudinal study included: (1) A need to rethink what evidence-based practice (EBP) really is; (2) How to practice EBP; and (3) The continuing challenge of measuring EBP. The co-development of actionable recommendations resulted in nine strategies.

CONCLUSIONS

This study highlighted how we may collectively promote EBP competencies in future OTs and PTs. We generated sector-specific avenues that may be pursued to promote EBP and argued for the importance of pooling efforts from the four sectors so that we may achieve the intended ethos of EBP.IMPLICATIONS FOR REHABILITATIONThere is a need to revisit the definition of evidence-based practice (EBP) and the traditional 3-circle model in rehabilitation to include a broader conceptualization of what constitutes evidence.We recommend using EBP measures as tools for self-reflection and professional development that can support practitioners to be reflective and accountable evidence-based practitioners.Optimal promotion of EBP competencies in occupational therapists and physiotherapists should rest upon collaborative efforts from the education, practice, research, and policy sectors.

Assessment of Evidence-Based Practice (EBP) among physiotherapists in Cameroon: a cross-sectional survey

BACKGROUND

Evidence-Based Practice (EBP) is reported to ease effective and adequate decision making for all works of life including health professionals. Investigating the level of implementation of EBP among physiotherapists helps to identify barriers and propose solutions for its extensive implementation. Despite available data on EBP elsewhere, it remains limited or non-existent in Cameroon. This study was designed to establish the current state of EBP among physiotherapists in Cameroon, by assessing knowledge, practice, and barriers to its implementation.

METHODS

A cross-sectional survey was conducted online among French- and English-speaking physiotherapists in Cameroon over a period of six months from April to July 2023, using the EBP2 questionnaire. This enabled us to collect socio-demographic data from participants and information on their knowledge, understanding and practice of EBP and possible barriers to EBP according to 5 domains (Confidence, Relevance, Terminology, Practice, Compatibility) scored out of 100. Data were analysed using IBM SPSS 25.0 software and Pearson correlations (95% CI) and significance (p < 0.05).

RESULTS

A total of 110 physiotherapists practising in the 10 regions of Cameroon participated in the study. The majority were male (54.5%), the median age was 34 years (age range 20 to 50), the median year of graduation was 2019 (range 2004 to max 2022) with 72.7% never having knowledge or training in EBP. Participants scored below 50/100 for 3 domains (confidence, relevance, and compatibility) showing poor general knowledge and understanding of EBP, although they generally had a positive attitude towards EBP. The use of EBP in practice was low (26.3/100 SD. 6.5), despite that they appeared to have a good understanding of research terminology (55.4 SD. 17.2). Level of study of participants did not appear to significantly influence domain scores (P > 0.05). The main barriers to practice were lack of time (75.1%), workload (66%), cost of access to information resources like databases for seek informations about recent support protocols (60%), ease of access to computers (49%), and lack of resources or skills (49%).

CONCLUSION

Physiotherapists in Cameroon have a poor knowledge of EBP and a low level of practice of EBP, despite an overall positive attitude towards it. These results could inform stakeholders of higher education on the need to improve training of physiotherapy students in the domain of EBP in Physiotherapy. Also, it will help in raising the level of scientific research and promoting the implementation of EBP in Cameroon.

Refining and adapting the measurement properties of evidence-based practice measures for physiotherapy students

OBJECTIVE

There is a lack of reliable and valid evidence-based practice (EBP) measures for physiotherapy students. This study validated EBP-student (EBP-S) measures for physiotherapy students.

METHODS

EBP measures developed from previous research were cross-culturally validated for use by physiotherapy students. The adapted EBP-S consisted of six measures: use of EBP, EBP activities, EBP knowledge, self-efficacy for EBP, attitudes towards EBP, and perceptions of the teaching and assessment of EBP in the curriculum. The final version was completed by physiotherapy students (n = 335). The psychometric properties for each EBP-S measure were estimated, including construct validity using Rasch model, internal consistency reliability using person separation index (PSI), test-retest reliability using intraclass correlation coefficient (ICC), and differential item functioning (DIF).

RESULTS

Two formative measures (use of EBP and EBP activities) were only linguistically modified for use with students. A Rasch model was applied to the other four reflective measures. For knowledge, 55% (6/11) items fit the Rasch model with chi-square fit statistic (χ2) = 34.46, p = 0.08; PSI = 0.85. For self-efficacy, 89% (8/9) items fit the Rasch model with χ2 = 25.11, p = 0.80; PSI = 0.89. For attitudes, 62% (8/13) items fit the Rasch model with χ2 = 61.49, p = 0.00; PSI = 0.71. For perception of the teaching and assessment of EBP in the curriculum, 62% (8/13) items fit the Rasch model with χ2 = 80.99, p = 0.45; PSI = 0.92. perception of the teaching and assessment of EBP in the curriculum showed DIF in three items. The ICCs ranged between 0.80 and 0.98.

CONCLUSIONS

The EBP-S measures were validated for physiotherapy students, including the testing of psychometric properties, which were not tested in the original studies. Further refinements should be considered for the use of the EBP-S with other groups of students or if changes are applied to the current curriculum.

Enhancing evidence-based practice into healthcare: Exploring the role of scientific skills in occupational therapists

BACKGROUND

Research utilization and evidence-based practice (EBP) in occupational therapy rely on essential scientific skills. Despite prior research exploring factors influencing EBP, a gap remains in understanding the specific scientific competencies crucial for effective EBP application.

OBJECTIVES

To (1) describe the level of scientific skills for EBP and research application, and (2) investigate the factors influencing higher scientific competence among 1159 Spanish-speaking occupational therapists.

MATERIAL AND METHODS

We assessed the scientific skills using the HACTO-Screen online survey. Recruitment was conducted through a non-probability convenience sampling method between April to June 2020, using social networks and email dissemination to education and professional organizations in Spain and Spanish-speaking Latin American countries.

RESULTS

Out of a total score of 115 points, participants showed a moderate level of scientific skills (mean: 62.7, SD: 21.6), with literature searching skills ranking the highest and scientific writing skills ranking the lowest. Associations were found between greater scientific competence and advanced degrees, ongoing research training, and on-the-job research.

CONCLUSIONS

Continuous research training, higher academic degrees, and active research engagement are essential for enhancing scientific competence among occupational therapists.

SIGNIFICANCE

Targeted training to enhance scientific skills and promote research utilization are crucial in advancing EBP in occupational therapy.

Being and Becoming an Evidence-Based Practitioner: Occupational Therapists' Journey Toward Expertise

IMPORTANCE

Despite mounting evidence for the management of various health care conditions, the uptake of scientific evidence in occupational therapy is often suboptimal. Although positive attitudes and self-efficacy are key to evidence-based practices (EBPs), how one becomes an evidence-based practitioner, and how expertise in EBP manifests in practice, remains unclear.

OBJECTIVE

To describe how expert evidence-based practitioners conceptualize and enact their expertise in stroke rehabilitation.

DESIGN

Qualitative interpretive descriptive study using in-depth semistructured interviews with eight occupational therapists identified as expert evidence-based practitioners in a previous study. Transcripts were analyzed using an inductive thematic content analysis, and emergent themes were identified.

SETTINGS

Rehabilitation settings across Canada.

RESULTS

Six overarching themes emerged: (1) relying on personal attributes to engage in practice improvement, (2) acting on factors that motivate and trigger EBP, (3) achieving better outcomes because of engagement in EBP, (4) using an adaptive decision-making process, (5) participating in professional activities that contribute to practice improvement, and (6) working in a practice area with a large body of evidence.

CONCLUSIONS AND RELEVANCE

Expertise in stroke rehabilitation EBP appears to be a function of several personal attributes and habits of mind in addition to being influenced by a commitment to client-centered practice. Expertise requires a combination of deliberate effort and motivation to improve client outcomes, always in a context conducive to reflection, adaptation, and openness to innovation. Experts who model these traits and articulate the processes used to develop their expertise can be viewed as promising educational and continuing professional development resources. What This Article Adds: Expert evidence-based occupational therapists develop their expertise in this domain through commitment to client-centered practice, efforts toward honing this aspect of practice, and a willingness to innovate and adapt to challenging situations.

Sexual Rehabilitation After a Stroke: A Multi-site Qualitative Study About Influencing Factors and Strategies to Improve Services

This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services.

Expected Health Benefits as the Ultimate Outcome of Information Available on Stroke Engine, a Knowledge Translation Stroke Rehabilitation Website: Web-Based Survey

BACKGROUND

Electronic knowledge resources are readily available and typically target different audiences, including health professionals and the public, that is, those with lived experience and their relatives. The knowledge-to-action framework, in combination with the information assessment method (IAM), considering both the value-of-information construct and the conceptual model of acquisition-cognition-application, can be used to support the evaluation process of such resources. As an example, Stroke Engine is an evidence-based knowledge translation resource in stroke rehabilitation (assessments and interventions) for health professionals and students as well as individuals who have sustained a stroke and their relatives. According to Google Analytics, the website is perused >10,000 times per week.

OBJECTIVE

With the overall aim to improve the content available on Stroke Engine, we documented Stroke Engine users' perceptions of situational relevance, cognitive impact, intention to use, and expected patient and health benefits regarding the information consulted.

METHODS

A web-based survey anchored in the IAM was made available via an invitation tab. The IAM is a validated questionnaire that is designed to assess the value of information. Sociodemographic characteristics were also collected, and a space for free-text comments was provided. Descriptive statistics were used, and thematic analysis was used for the free-text comments.

RESULTS

The sample consisted of 6634 respondents. Health professionals (3663/6634, 55.22%) and students (2784/6634, 41.97%) represented 97.18% (6447/6634) of the total responses. The remaining 2.82% (187/6634) of the responses were from individuals who had sustained a stroke (87/6634, 1.31%) and their relatives (100/6634, 1.51%). Regarding situational relevance, assessments (including selecting, obtaining, and interpreting results from a test) was the main topic searched by health professionals (1838/3364, 54.64%) and students (1228/2437, 50.39%), whereas general information on stroke rehabilitation was the top-ranked topic for nearly two-thirds of the individuals with stroke (45/76, 59%) and their relatives (57/91, 63%). Cognitive impact was characterized by learning something new. Intention to use was high (4572/6379, 71.67%) among the respondents and varied in context (eg, refine a topic, research, class assignments, teaching, and education). Respondents commented on ways to improve content. Expected patient and health benefits such as improvement in health and well-being was the top-ranked category for all 4 subgroups, followed by the avoidance of unnecessary or inappropriate treatment for health professionals (183/623, 29.4%) and a feeling of being reassured for individuals with stroke (26/75, 35%) and their relatives (28/97, 29%).

CONCLUSIONS

Valuable feedback on Stroke Engine was obtained in terms of its accessibility, relevance for informational needs and retrieval, accuracy, and applicability; however, of utmost importance is the potential implementation of its evidence-based content in clinical practice and the perceived expected impact on patients, their relatives, and their health professionals. The feedback received allowed for corrections and the identification of key topics for further development.

Thirty years of teaching evidence-based medicine: have we been getting it all wrong?

Evidence based medicine (EBM) has been synonymous to delivery of quality care for almost thirty years. Since the movement's inception, the assumption has been that decisions based on high quality evidence would translate to better care for patients. Despite EBM's many attractive features and the substantive attention it has received in the contemporary clinical and medical education literature, how it is defined and operationalized as a component of training is often unclear and problematic. How to practice EBM is not well articulated in the literature; therefore, it becomes difficult to teach and equally challenging to assess. In this paper, we put forward a call for deeper consideration of how EBM is taught, and for clarification on how it is defined and operationalized in medical education. In preparing this paper, we considered questions such as what it means to practice EBM, the role that medical education plays in helping realize EBM, how the teaching of EBM can change to reflect recent developments in clinical practice and education, and whether transformations in the practice of medicine necessitate a change in how we teach EBM. We end with four avenues that may be pursued to advance the teaching of EBM in medical education: (1) consensus on what we mean by EBM; (2) clear articulation of EBM-associated competencies; (3) empirically and theoretically supported means of promoting EBM competencies; (4) ways to assess both skill acquisition and use of EBM. We discuss implications for educators of EBM.