Undergraduate medical students' perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria

Factors influencing research productivity among Syrian medical professionals amidst conflict: a case-control study

BACKGROUND

Medical research productivity is globally increasing, with a lagging progress in third-world countries due to significant challenges, including inadequate training and brain drain. Syria had been showing a slow upward trend until the war broke out and severely hindered academic growth and productivity. A deeper understanding of the factors influencing research productivity in this context are fundamental to guide educational policies and resource allocation. Previous cross-sectional studies that evaluated the perspectives of Syrian academics on the issue were limited by the small sample size of published healthcare workers, making it difficult to identify the factors that enabled them to pursue research.

METHODS

To address this challenge, we employed a case-control design. We isolated published early-career Syrian healthcare workers and compared their characteristics and perceptions to unpublished matched controls. Authors in the fields of medicine, dentistry, and pharmacy affiliated with any Syrian University were identified through an extensive search of PubMed and Google Scholar.These authors were invited to complete a questionnaire that covered participants' research contributions, alongside their self-assessed knowledge, attitudes, and barriers towards research. The questionnaire was publicly published to recruit an equal sample of matching controls, with half consisting of unpublished researchers and the other half of participants without prior research contributions.

RESULTS

Six-hundred-sixteen participants were recruited. Their knowledge, attitudes, and perceived barriers explained 46% and 34% of the variability in research involvement and publication, respectively (P < 0.001). Getting involved in and publishing research studies associated with higher research-related knowledge and attitudes (P < 0.001). Respondents' assessment of research-related barriers and their academic scores did not differ between cases and controls. Superior research-related knowledge and attitudes were associated with male gender, higher English competency, and better internet connectivity. Meanwhile, extracurricular training and mentors' support were associated with more positive research-related attitudes and less perceived barriers.

CONCLUSIONS

Research productivity of medical professionals in Syria exhibits a positive correlation with their knowledge and favorable attitudes towards medical research. Noteworthy, the demographic variations are linked to disparities in research-related knowledge and motivation. In conclusion, these results suggest a potential avenue for enhancement through concentrated efforts on improving extracurricular training interventions and mentors' support.

Numeracy Education for Health Care Providers: A Scoping Review

INTRODUCTION

Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies.

METHOD

A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results.

RESULTS

The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement.

DISCUSSION

Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication.

Identification of alternative topics to diversify medicine, dentistry, and pharmacy student theses: a mixed method study

INTRODUCTION

The impact of medicine, dentistry, and pharmacy student theses on public health is a crucial concern for policymakers in medical science universities. If student theses correspond to the needs of society, they can significantly affect students' scientific and practical abilities and lead to the provision of more efficient health services. This study aimed to identify alternative topics to diversify medicine, dentistry, and pharmacy student theses.

METHODS

This mixed method study with an exploratory sequential design was conducted at Kerman University of Medical Science from February to June 2021. The qualitative component entailed a focus group of faculty members (n = 16) and students (n = 4) to extract alternative topics to diversify medicine, dentistry, and pharmacy student theses. The quantitative component included a questionnaire based on emerging subjects and literature review to evaluate the extracted alternative topics. Qualitative data were analyzed using conventional content analysis and quantitative data were analyzed descriptively.

RESULTS

A total of 20 key participants took part in the focus group meeting, and from 20 questionnaires, 15 were returned with a response rate of 75%. A list of 18 alternative topics was generated and five categories were identified: individual development, research, education, healthcare, and social services.

CONCLUSIONS

The gap between what we know and what is seen in practice is quite large in medical and health-related professions. Alternative topics for medicine, dentistry, and pharmacy student theses contribute to turning knowledge into practice.

Comparison of two validated evidence-based medicine assessments: Do they correlate?

Evidence-based medicine (EBM) has been defined as a process involving five actions: asking, acquiring, appraising, applying, and assessing. Several attempts have been made to create and validate tools to assess EBM aptitude. The newest testing instrument, the ACE tool, which is a 15-question true/false exam, has not been directly compared to the more established Fresno test, which is composed of 12 in-depth short-answer questions. Although both were designed to test Steps 1-4 of the five-step EBM process, it is unclear whether they examine the same things or whether one is superior. To our knowledge there is not a widely used standard for EBM assessment despite the broad requirements for inclusion of EBM in both undergraduate and graduate medical education.

Hypotheses

It was hypothesized that these instruments do not correlate between one another, based on inherent differences between them, including assessment format, grading method, and scoring range. The authors sought to examine whether a correlation between the results of these two instruments exists in a population of U.S. medical students.

Methods

A retrospective cohort study of 158 fourth-year U.S. medical students in academic year 2018-2019 was conducted. All students were exposed to a focused EBM curriculum, consisting of three guided discussions of separate journal articles clinically relevant to the practice of emergency medicine. Outcomes measured included scores on both the ACE tool and Fresno test using descriptive statistics. Spearman's rho was used to determine the correlation between the ACE and Fresno scores for each student among the entire group. A subgroup analysis was performed to assess for correlations at more extreme data points.

Results

The median scores on the ACE tool and Fresno test were 66.7% and 62.7%. There was no statistically significant correlation between the results of these two assessments (Spearman's rho 0.023, p = 0.774) in our population. The scores from the subgroup of advanced performers on the Fresno test showed a weak statistically significant positive correlation (p = 0.045) to advanced scores on the ACE tool. No other subgroups showed statistically significant correlation.

Conclusions

In our population of U.S. medical students, the results of two known EBM assessment instruments do not correlate with one another. The assessments may differ in what categories of learning they measure or in generalizability or perhaps in what depth of understanding they test overall. Further study is needed to determine what each instrument is measuring and whether there is demonstrable variation across populations.

Knowledge, attitude, and practice of evidence-based medicine among resident physicians in hospitals of Syria: a cross-sectional study

BACKGROUND

Evidence-based medicine (EBM) is to integrate the best research evidence with our clinical expertise, circumstances, and unique values of our patient. However, there are no studies about using EBM in clinical practice among resident doctors in Syria. In this study, we aimed to evaluate the self-reported knowledge, attitude and practice (KAP) of EBM by resident doctors throughout different teaching hospitals in Syria.

METHODS

The study is a cross-sectional. A self-reported online questionnaire was used to collect data about KAP of EBM from 214 resident physicians working in secondary and tertiary teaching hospitals. The study was conducted between September 2021 and February 2022. All data were analyzed using SPSS, and non-parametric statistical tests were used to identify the correlation between different variables and make the necessary comparisons.

RESULTS

Two hundred and fourteen physicians responded to the questionnaire with a response rate of 85.6%. The overall mean scores of KAP of EBM were 59.2, 74.3 and 53.9%, respectively. The participants displayed a low level of awareness of resources and statistical terms used in EBM. The most well-known resources for residents were Up To Date and PubMed. Among the participants, pediatric residents achieved the highest score in practicing EBM, while family medicine residents scored the lowest score.

CONCLUSION

The overall impression about the KAP of EBM among Syrian residents was as following: weak awareness, neutral attitude and poor practice of EBM. Training workshops should be set up to teach residents the skills needed to move from opinion-based practice to evidence-based practice.

Medical Research Conduct and Publication during Higher Education in Syria: Attitudes, Barriers, Practices, and Possible Solutions

Background:  The huge workload on doctors especially residents, who are the main health care providers in public hospitals, in addition to the vanishing incomes and lack of personal safety during the decade-long Syrian crisis, led to further hurdles in the focus on research. Postgraduate students in the medical and paramedical fields must conduct original research projects as part of their graduation requirements. However, this does not reflect on research publications coming from Syria.

Methods:  This is a nation-wide cross-sectional study targeting medical, dental, and pharmacy postgraduate students who are at the phase of planning for their required projects. The questionnaire aimed to capture their attitudes toward research, perceived barriers, and previous research experiences in order to suggest evidence-based recommendations.

Results:  The sample consisted of 429 residents representing about 22% of the target population. Nearly all the participants had positive opinion toward the important role of medical research and the significance of their participation. Agreement was also clear regarding perceived barriers, including the lack of adequate training and research facility. Seventy-one percent of the participants were not involved in any research before the time of their master theses, less than 13% of them had submitted an article for publication, and less than 5% had submitted more than one paper. Despite that, high-quality internet connectivity and rich English writing skills were associated with further research experiences. Additionally, mentors' support and self-paced learning of research skills had significant positive impact on students' research contributions with odds ratios of 2.04 [[95% Confidence Interval]: 1.02–4.06] and 2.68 [1.48–4.84], respectively.

Conclusion:  Lack of training and mentorship, in addition to several common barriers to medical research, hampered residents' capacity of conducting and publishing research despite their positive attitudes toward it. Nevertheless, the variance within our sample exposed a promising window for implementing low-cost institutional and individual solutions such as peer-run self-paced training opportunities and long-distance mentoring.

Predictors of evidence-based practice competency among Tunisian nursing students

BACKGROUND

Evidence-based practice (EBP) is an important competency of undergraduate nursing students which should be cultivated before graduation by increasing future healthcare providers' knowledge, skills and attitudes towards EBP. This study aimed to describe nursing students' competencies (attitudes, knowledge, skills) in Evidence-based practice (EBP) and to determine factors predicting EBP competency.

METHODS

A descriptive cross-sectional study was conducted at the Higher School of Health Sciences and Techniques of Sousse (Tunisia) among 365 nursing students. Data were collected using the validated Evidence Based Practice Competencies Questionnaire (EBP-COQ). Multiple linear regression was performed to determine factors predicting EBP competencies.

RESULTS

The overall score of EBP-COQ questionnaire was 3.26 ± 0.53 out of 5. The attitude, skills and knowledge subscales received 4.04 ± 0.41; 3.05 ± 0.77 and 2.70 ± 0.74 as mean scores respectively. Multiple linear regression analysis (table 4) revealed that significant related factors were academic level (β = 0.271, p = 0.001), English-language reading skills (β = 0.435, p < 0.001), facing staff resistance in implementing a new evidence-based procedure (β = - 0.081, p = 0.035) difficulties in obtaining full-text papers (β = - 0.127, p < 0.001) and training in methodology (β = 0.232, p < 0.001) and also in statistics (β = 0.205, p < 0.001).

CONCLUSIONS

These results help to understand students' attitudes, knowledge and skills in EBP and can be therefore a starting point to develop effective strategies for EBP curricula.

Evidence-based medicine (EBM) for undergraduate medical students in Sudan: sources of information, knowledge about terms, skills related to EBM and attitude toward EBM in Sudan

BACKGROUND

Evidence-based medicine (EBM) is the use of the current best evidence for patient care. Medical students should critically appraise the research evidence to help them during their clinical practice in the future. We conducted this study to assess the skills, terms and attitude toward EBM.

METHOD

We conducted a cross-sectional study for medical students from governmental universities. Students completed an online validated questionnaire consisting of several sections to assess skills, attitude and knowledge about terms related to EBM. We used a scale ranging from 1(strongly disagree) to 5(strongly agree) for the 11 questions assessing the attitude and a scale ranging from 1(Poor) to 5(advanced) for EBM skills.

RESULTS

A total of 761 medical students with a mean age of 21.97 ± 1.64 participated in the study. 327 (43 %) of them were males. The most commonly used search engines were Google 690 (91 %) and Wikipedia 465 (61 %). Medical books 719 (94 %) and lecture notes 353 (46 %) were the most common sources for health information. The majority of students rated their skills related to EBM as average and below average for all questions (overall = 2.18 ± 0.8). Students rated their skills as poor (31 %) in locating professional literature, as average (34 %) in searching online databases, poor (42 %) in critical appraisal of a scientific publication reporting findings from clinical research and poor (36 %) in Critical appraisal of available scientific literature. Regarding attitude, the overall mean score was 2.83 ± 0.76. There is no significant difference in attitude score between students with or without EBM training (P = 0.2). The terms with the highest understanding were case-control study (45 %) and case report (44 %) for study design. Median (44 %) and sample size (43 %) for statistics. Incidence (46 %) and prevalence (44 %) for epidemiology.

CONCLUSIONS

Medical students have a knowledge gap in skills and terms related to EBM and an average attitude towards EBM. The majority of them were using a nonscientific search engine to obtain medical information. There is a need to educate students about the proper steps for getting the scientific literature and EBM skills.

An online academic writing and publishing skills course: Help Syrians find their voice

PURPOSE

A group of Arab-American physicians and researchers in the United States organized a blended online course in academic writing and publishing in medicine targeting medical students and physicians in war-torn Syria. This was an effort to address one of the reasons behind the poor quantity and quality of scientific research papers in Syria and the Arab region. In this paper, we report on the design, conduct, and outcome of this course and attempt to evaluate its effectiveness.

METHODS

The educational intervention was a 2-month blended online course. We administered a questionnaire to assess satisfaction and self-reported improvement in knowledge, confidence, and skills of academic writing and publishing.

RESULTS

The course succeeded in reaching more than 2588 physicians and medical students from the region; 159 of them completed most of the course. Eighty-three percent of the participants felt that they were confident enough to write an academic paper after the course and 95% felt the learning objectives were achieved with an average student satisfaction of 8.4 out of 10.

CONCLUSION

Physicians in Syria and neighboring countries are in need of training to become an active part of the global scientific community and to document and communicate the crisis their countries are going through from a medical perspective. Low-cost online educational initiatives help respond, at least partially, to those needs.

Factors Associated with Practicing Evidence-Based Medicine Among Medical Interns in Amhara Regional State Teaching Hospitals, Northwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Evidence-based medicine (EBM) is an important component of modern medicine and is essential for the provision of high-quality health services. Little is known about the level of EBM use among Ethiopian medical students. This study aimed to assess the factors associated with EBM practice among medical interns in teaching hospitals in northwestern Ethiopia.

METHODS

A cross-sectional study was conducted using a random sample of medical interns in teaching hospitals of northwest Ethiopia. Binary logistic regression analysis was used to identify factors associated with EBM practice. The strength of the interaction between variables was calculated using the adjusted odds ratio (AOR) with a 95% confidence interval (CI).

RESULTS

Completed questionnaire was obtained from 403 (95.3%) of 423 medical interns. About 48.4% of respondents had a good EBM practice. EBM knowledge (AOR = 1.86, 95% CI = 1.220-2.835), attitude to EBM (AOR = 2.05, 95% CI = 1.318-3.193), ability to appraise evidence (AOR = 2.35, 95% CI = 1.570-3.517), and having sufficient time to search for evidence (AOR = 1.67, 95% CI = 1.065-2.627) were factors significantly associated to EBM practice.

CONCLUSION

This study demonstrates that the main factors affecting medical intern's practice of EBM were lack of critical appraisal skill, lack of knowledge needed to practice EBM, negative attitudes toward EBM, and insufficient time to search for evidence. Providing EBM training to the needs of medical interns would overcome the barriers identified in this study, as well as assist medical interns and other clinical staffs to ensure the correct application of EBM in to clinical practice.

Knowledge and Attitude Toward Evidence-Based Medicine and Associated Factors Among Medical Interns in Amhara Regional State Teaching Hospitals, Northwest Ethiopia: Cross-sectional Study

BACKGROUND

Evidence-based medicine (EBM) is widely accepted in medicine. It is necessary to improve the knowledge and attitudes of medical students in the use of evidence. In Ethiopia, little is known about medical students' knowledge and attitudes toward EBM.

OBJECTIVE

This study aimed to assess the knowledge and attitudes toward EBM and its associated factors among medical interns in teaching hospitals.

METHODS

A cross-sectional survey was conducted using a random sample of medical interns in teaching hospitals in Ethiopia. Multivariable logistic regression analyses were used to identify the factors associated with the knowledge and attitudes toward EBM. Adjusted odds ratio (AOR) with 95% confidence interval and P≤.05 was used to quantify strength of association between variables.

RESULTS

Out of a sample of 423 medical interns, 403 completed the questionnaire (95.3% response rate). Overall, 68.0% (274/403 of respondents had a favorable attitude toward EBM and 57.1% (230/403) had good knowledge of EBM. The majority (355/403, 88.1%) of participants had internet access. Only 19.6% (79/403) of respondents had received EBM-related training. Respondents' knowledge of EBM was associated with previous EBM training (AOR 2.947, 95% CI 1.648-5.268, P<.001), understanding of sensitivity (AOR 2.836, 95% CI 1.824-4.408, P=.003), and internet access (AOR 2.914, 95% CI 1.494-5.685, P=.002). The use of an electronic database as a source of information (AOR 1.808, 95% CI 1.143-2.861, P=.01) and understanding of absolute risk reduction (AOR 2.750, 95% CI 1.105-6.841, P=.03) were predictors of positive attitudes.

CONCLUSIONS

This study demonstrates a lack of formal EBM training and awareness of basic concepts of EBM among medical interns. Medical intern attitudes toward EBM are relatively good. To enhance EBM knowledge and skills, formal teaching of EBM should be integrated into medical education.

Self-perception of competences in clinical practice among recently graduated physicians from Lima, Peru

Objective

To describe the self-perception of basic competencies in clinical practice and evaluate their associated factors, among recently graduated physicians from Lima, Peru.

Methods

Cross-sectional study. We evaluated the self-perception of the competencies in recently graduated physicians of four dimensions of the Tuning Project. Each item had six possible responses on a Likert scale: "non-existent" (1 point), "insufficient" (2 points), "sufficient" (3 points), "good" (4 points), "very good" (5 points) and "excellent" (6 points). To evaluate associated factors of the average scores for each dimension, we used linear regressions with the bootstrap method.

Results

We analyzed data from 425 (54.9% were between 22 and 25 years old), which represent 31.1% of all physicians who graduated in 2016 from all medical schools located in Lima. The average self-perception score of the assessed dimensions was, in descending order: 4.49 for carrying out a patient consultation with a patient; 4.13 for carrying out practical procedures; 4.12 for providing immediate care of medical emergencies; and 4.04. for applying the principles, skills, and knowledge of evidence-based medicine (EBM). Regarding the factors associated with the average score per dimension, physicians from one university had higher average scores in all dimensions, and having done an externship and done an internship at social security hospitals was associated with a higer score with self-perception in two dimensions.

Conclusion

Self-perception of competence was greater for the patient consultation dimension, and lower for the EBM. Only physicians from one university had higher average scores in all dimensions.

Examining aptitude and barriers to evidence-based medicine among trainees at an ACGME-I accredited program

BACKGROUND

The aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients' outcome (Profetto-McGrath J, J Prof Nurs Off J Am Assoc Coll Nurs 21:364-371, 2005). Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients' care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East.

METHODS

Clinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees' attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed.

RESULTS

The average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM.

CONCLUSIONS

While it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice.

Effect of training on evidence-based practice to undergraduate dental students: pre and postexperimental study

BACKGROUND

Evidence-based practice (EBP) training is essential for undergraduate students in making sound clinical decisions during patient care. However, EBP training is not included in the curriculum of undergraduate dental students in India and there is a dearth of research that assessed the effectiveness of EBP training in India. Hence, this study aimed to assess the effectiveness of EBP training to dental undergraduate students.

METHODS

Final year undergraduate students and interns of a dental institution participated in this pre and postexperimental study. All the participants received a 2-day workshop (didactic lectures, hands-on and group activities) in a classroom setting. A validated 35 item instrument titled EBP Knowledge, Attitudes, Access and Confidence questionnaire was used for the outcome assessment of EBP training.

RESULTS

Fifty undergraduate students (33 interns and 17 final year) participated in the study. Statistically significant improvement was observed in six out of 10 items related to EBP knowledge. All the items related to attitude showed a significant positive change in scores. Only four out of nine items related to accessing evidence showed a statistically significant change. Participants reported moderate confidence gain in critical appraisal skills.

CONCLUSION

The current study demonstrated moderate improvement in the effectiveness of EBP training in improving EBP knowledge, accessing evidence and critical appraisal skills.

Medical student perceptions of research training on patient care during clerkship

This article was migrated. The article was marked as recommended. Background Health Science Research (HSR) is a pre-clerkship component of the University of Toronto (U of T) MD Program. Through online modules and tutorials, students learn to understand and apply research, and write an original research protocol. This study explored students' perceptions on how HSR prepared them to identify, critically appraise and consume research during clerkship. Methods An online 12-item questionnaire surveyed U of T medical students (Class of 2018) who completed HSR in 2016. Basic descriptive statistics were performed; free text responses were analysed via descriptive thematic analysis. Results Twenty six percent (67/262) of students participated. Approximately half either agreed/strongly agreed that HSR helped them to critically appraise research articles (50.7%, 32/63) and assess applicability of results to patient care (50.8%, 32/63). Three themes emerged: i) desire for increased critical appraisal, ii) producing research less important than consuming research, iii) developing a greater appreciation of research during clerkship. Conclusions Students' perceptions on HSR's value during clerkship were modest; they desired greater focus on learning to be consumers of research. These results will refine HS, and our observations may be useful to other educators, as this type of intervention is not represented in existing literature.

Adaptation and validation of the Berlin questionnaire of competence in evidence-based dentistry for dental students: a pilot study

BACKGROUND

The purpose of this pilot study was to create a valid and reliable set of assessment questions for examining Evidence-based Dentistry (EbD) knowledge. For this reason, we adapted and validated for dental students the Berlin Questionnaire (BQ), which assesses Evidence-based Medicine (EbM) abilities.

METHODS

The Berlin Questionnaire was validated with medical residents. We adapted it for use in a dentistry setting. An expert panel reviewed the adapted BQ for content validity. A cross-sectional cohort representing four training levels (EbD-novice dental students, EbD-trained dental students, dentists, and EbM-/EbD-expert faculty) completed the questionnaire. A total of 140 participants comprised the validation set. Internal reliability, item difficulty and item discrimination were assessed. Construct validity was assessed by comparing the mean total scores of students to faculty and comparing proportions of students and faculty who passed each item.

RESULTS

Among the 133 participants (52 EbD-novice dental students, 53 EbD-trained dental students, 12 dentists, and 16 EbM-/ EbD-expert faculty), a statistically significant (p < 0.001) difference was evident in the total score corresponding to the training level. The total score reliability and psychometric properties of items modified for discipline-specific content were acceptable. Cronbach's alpha was 0.648.

CONCLUSION

The adapted Berlin Questionnaire is a reliable and valid instrument to assess competence in Evidence-based Dentistry in dental students. Future research will focus on refining the instrument further.

Efficacy of evidence-based medicine training for primary healthcare professionals: a non-randomized controlled trial

BACKGROUND

The impact of evidence-based medicine (EBM) training techniques in primary healthcare professionals remains to be determined.

METHODS

A non-randomized controlled trial (NRCT) was performed aiming to assess the two methods of evidence-based medicine training for primary healthcare professionals by assessing evidence based practice (EBP) related knowledge (EBP-K), attitude (EBP-A), personal application (EBP-P), anticipated future use (EBP-F), and community management of hypertension. Participants were recruited and assigned to either an EBM training group that receiving a weekly face-to-face EBM training course, or an EBM self-instruction course for eight weeks. A validated instrument was applied to evaluate the four aspects of EBP. Additionally, community management of hypertension was assessed by comparing the the rate of detection, blood pressure control, standard management, grading management and patient satisfaction between 2015 and 2016 to measure training efficacy. The difference between the impact of these two interventions was assessed statistically.

RESULTS

One hundred fifty-one participants (69 in the face-to-face EBM training group and 82 in the self-instruction group) were included. Compared to self-instruction, the face-to-face EBM training was associated with significantly improved EBP-Knowledge (26.14 ± 4.22 vs. 22.44 ± 4.47, P < 0.05), EBP-Personal application (22.52 ± 6.18 vs. 16.89 ± 5.99, P < 0.05), and EBP-Future use (44.04 ± 8.97 vs. 37.71 ± 8.39, P < 0.05). EBP-Attitude scores (10.89 ± 4.52 vs.14.93 ± 5.92, P < 0.000) were lower in the EBM training group. Stratified analyses showed that the results were consistent regardless of the participants' gender, professional role (doctors & apothecaries or nurses), rank (junior or senior doctors & apothecaries), or specialty (Traditional Chinese or Western Medicine). Assessment of community hypertension management revealed that the rate of blood pressure control, standardized hypertension management and patient satisfaction was significantly better in group A than group B (1.14% vs.0.69, 2.85% vs.1.68 and 2.41% vs.0.84%).

CONCLUSIONS

A face-to-face EBM training course improved primary healthcare professionals' EBP knowledge, attitudes, personal application, and anticipated future use. Effective EBM training may improve the efficacy of primary health care services.

TRIAL REGISTRATION

Non-Randomized Controlled Trial ChiCTR1800017498 , August 1, 2018.

How to choose an evidence-based medicine knowledge test for medical students? Comparison of three knowledge measures

BACKGROUND

There are a few studies of alignment between different knowledge-indices for evidence-based medicine (EBM). The aim of this study was to investigate whether the type of test used to assess knowledge of EBM affects the estimation of this knowledge in medical students.

METHODS

Medical students enrolled in 1-week EBM course were tested with the Fresno, Berlin, and ACE tests at the beginning and the end of the course. We evaluated the ability of these tests to detect a change in the acquired level of EBM knowledge and compared the estimates of change with those of the Control group that was tested with the ACE and Berlin tests before and after an unrelated non-EBM course. The distributions of test scores and average item difficulty indices were compared among the tests and the groups.

RESULTS

Test scores improved on all three tests when compared with their pre-test results and the control. Students had on average a "good" performance on the ACE test, "sufficient" performance on the Berlin test, and "insufficient" performance or have "not passed" on the Fresno test. The post-test improvements in performance on the Fresno test (median 31% increase in percent scores, 95% confidence interval (CI) 25-42%) outperformed those on the ACE (13, 95% CI 13-20%) and Berlin tests (13, 95% CI 7-20%). Post-test score distributions demonstrated that the ACE test had less potential to discriminate between levels of EBM knowledge than other tests.

CONCLUSION

The use of different EBM tests resulted in different assessment of general EBM knowledge in a sample of graduate medical students, with lowest results on the Fresno and highest on the ACE test. In the light of these findings, EBM knowledge assessment should be based on the course's content and learning objectives.

The effect of an evidence-based medicine course on medical student critical thinking

OBJECTIVE

Evidence-based medicine (EBM) was designed to foster student critical thinking (CT) while conveying knowledge to them. Chinese medical schools have adopted EBM to a varying degree but studies to examine its intended effect are few. This study evaluates the effect of an EBM course on Chinese medical student CT.

METHODS

A total of 158 medical students at a Chinese medical school took a seven-category Chinese version of the critical thinking disposition inventory (CTDI-CV) before and after taking an EBM course. Two-tailed, paired t-test measured the course effect.

RESULTS

Undergraduate (BS) students showed a significant mean difference (MD) in confidence (MD = 1.43, P = 0.025), inquisitiveness (MD = 1.23, P = 0.041), and overall score (MD = 3.45, P = 0.000). Graduate (MS) students showed a more significant mean difference in confidence (MD = 2.72, P = 0.006). Moreover, BS student course grade was correlated with truth-seeking (r = 0.214, P = 0.029) and open-mindedness (r = 0.246, P = 0.012) while that of MS student was correlated with systematicity (r = 0.295, P = 0.031) and overall score (r = 0.290, P = 0.033).

CONCLUSIONS

The results indicate some positive effect of an EBM course on student CT due to embedded CT elements in delivering the content. The discrepancy between a higher admission test score and weaker confidence shown by MS students reveals a drawback of the test centered Chinese education system.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The impact of clinical maturity on competency in evidence-based medicine: a mixed-methods study

OBJECTIVE

To identify whether the clinical maturity of medical trainees impacts upon the level of trainee competency in evidence-based medicine (EBM).

MATERIALS AND METHODS

Undergraduate and graduate-entry medical trainees entering their first year of training in the clinical environment were recruited for this study. Competency in EBM was measured using a psychometrically validated instrument. EBM competency scores were analysed using Student's t tests, in order to differentiate between undergraduate and graduate-entry trainee performance. Ten focus group discussions were conducted with undergraduate and graduate-entry trainees. Audio transcripts were thematically analysed.

RESULTS

Data on a total of 885 medical trainees were collected over a 5-year period. Undergraduate trainees had significantly higher EBM competency scores during years in which the programme was presented in a didactic format (mean difference (MD)=1.24 (95% CI)CI 0.21 to 2.26; 1.78 (0.39 to 3.17); 2.13 (1.16 to 3.09)). Graduate trainee EBM competency scores increased when a blended learning approach to EBM was adopted, demonstrating no significant difference in EBM competency scores between undergraduate and graduate cohorts (-0.27 (-1.38 to 0.85); -0.39 (-1.57 to 0.79). Qualitative findings indicated that differences in learning and teaching preference among undergraduate and graduate-entry trainees influenced the level of competency obtained in EBM.

CONCLUSIONS

Clinical maturity is the only one factor that may influence medical trainees' competency in EBM. Other predictors of EBM competency may include previous training and exposure to epidemiology, biostatistics and information literacy. While graduate-entry medical students may have more 'life' experience, or maturity, it does not necessarily translate into clinical maturity and integration into the clinical environment.

Case reports and research productivity among Syrian medical students: Review, reality, and suggested solutions

Medical students are precious seeds for better future medical research. Case reports writing may represent a relatively simple first step for beginners. Only 47 case reports are published in the literature by Syrian Medical Institutions compared to more than 500 case reports in a comparable country in the last 5 years. Many obstacles stand against developing fruitful research environment in Syria. Increasing awareness to research productivity in Syria along with comparative analysis is discussed in this article.

Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges

Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student’s knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students’ perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students’ skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.

Online training course on critical appraisal for nurses: adaptation and assessment

BACKGROUND

Research is an essential activity for improving quality and efficiency in healthcare. The objective of this study was to train nurses from the public Basque Health Service (Osakidetza) in critical appraisal, promoting continuous training and the use of research in clinical practice.

METHODS

This was a prospective pre-post test study. The InfoCritique course on critical appraisal was translated and adapted. A sample of 50 nurses and 3 tutors was recruited. Educational strategies and assessment instruments were established for the course. A course website was created that contained contact details of the teaching team and coordinator, as well as a course handbook and videos introducing the course. Assessment comprised the administration of questionnaires before and after the course, in order to explore the main intervention outcomes: knowledge acquired and self-learning readiness. Satisfaction was also measured at the end of the course.

RESULTS

Of the 50 health professionals recruited, 3 did not complete the course for personal or work-related reasons. The mean score on the pre-course knowledge questionnaire was 70.5 out of 100, with a standard deviation of 11.96. In general, participants' performance on the knowledge questionnaire improved after the course, as reflected in the notable increase of the mean score, to 86.6, with a standard deviation of 10.00. Further, analyses confirmed statistically significant differences between pre- and post-course results (p < 0.001). With regard to self-learning readiness, after the course, participants reported a greater readiness and ability for self-directed learning. Lastly, in terms of level of satisfaction with the course, the mean score was 7 out of 10.

CONCLUSIONS

Participants significantly improved their knowledge score and self-directed learning readiness after the educational intervention, and they were overall satisfied with the course. For the health system and nursing professionals, this type of course has the potential to provide methodological tools for research, promote a research culture, and encourage critical thinking for evidence-based decision making.

Knowledge and attitude toward evidence-based medicine among medical students in Semnan, Iran

OBJECTIVES

Evidence-based medicine (EBM) has gained widespread acceptance in medicine. Little is known about the attitudes, knowledge, and behavior of medical students toward EBM in developing countries. This study was designed to assess medical students' awareness and attitudes toward EBM and to obtain the basis required for developing appropriate teaching and learning opportunities.

METHODS

This was a cross-sectional study in which medical students completed a questionnaire to determine their attitudes, knowledge, and perceptions regarding EBM.

RESULTS

Completed questionnaires were received from 84% (143) of 170 medical students. Only 24.5% of respondents had good basic information and familiarity with the term of EBM. The majority (89.3%) of participants had positive attitude toward EBM and agreed that it was useful in the management of patients. Mostly were interested in learning the skills of EBM. Most of the respondents (80.2%) had no or little awareness of EBM resources especially the Cochrane, DARE, and Bandolier clinical evidence database. Forty-two (29%) reported having had formal training in search strategies. Most of the respondents did not understand but would like to learn about technical terms used in EBM, and about a third felt able to explain to others the meaning of some of these terms.

CONCLUSIONS

This study demonstrates lack of adequate knowledge about basic concepts of EBM among medical student. On the other hands, there is an overall positive attitude toward EBM. There is need for educational interventions and incorporating formal teaching of EBM at medical education.