18 A multifaceted, clinically integrated evidence based medicine curriculum improves medical students’ competency as measured by the fresno test

Abstract

Objectives The University of Buckingham Medical School (UBMS) is an independent medical school in the UK. Following feedback from students that they struggled to understand the relevance of Evidence Based Medicine (EBM) to clinical practice, the EBM curriculum was revised. A longitudinal, competency based, multifaceted, clinically integrated curriculum, with assessments has been designed and implemented. The aim of this study was to assess the effectiveness of the new EBM curriculum to improve students’ competency using the validated Fresno test and their attitudes. Method Blended learning approaches have been incorporated with a mix of didactic lectures, facilitated small group discussions and peer teaching of phase I (years one and two) students of the relevance of EBM to clinical practice by phase II (years three and four) students using their personal experiences in clinical rotations. Formative and summative assessments have been designed to capture written demonstration of EBM knowledge and skills as applied to clinical scenarios in short answer format. All students from the 2017 cohort that experienced the first iteration of the integrated curriculum were invited to participate. The Fresno test of EBM competence was administered as a formative assessment test before and after the EBM teaching through our virtual learning environment. Self-reported students’ attitudes and knowledge of EBM, its relevance to clinical practice were assessed and students were invited to participate in a focus group discussion at the end of EBM teaching. Results Of the 83 students invited, 31 participated at baseline (37.3%) and 55 participated at the end of the study (66.3%). 18 students attempted the Fresno test at baseline as well as at follow-up. The average score for the test was significantly higher after teaching than at baseline, with the average score increasing by 38.7 marks, from 29.3 at baseline to 68.0 after teaching ( p 0.001 ). Analyzing responses to questionnaires from the same 18 students, showed that compared to baseline, after EBM teaching, a higher proportion of students felt confident in critically appraising journal articles and in formulating clinical questions to search for evidence. Five students participated in the focus group discussion and key themes identified were increased students’ perceptions of the relevance of EBM to clinical practice, preference for interactive workshops over didactic lectures for literature searching skills and incorporating EBM teaching across the curriculum. Conclusions It has been feasible to design and implement a multi-faceted, clinically integrated EBM curriculum in undergraduate medical education. Early evaluation of the curriculum using the Fresno test and focus group discussions has shown an improvement in EBM knowledge, skills and students’ perceptions of the clinical relevance of EBM. The Fresno test has been a useful formative assessment to assess medical students’ competency in EBM- the first three steps- ask, acquire and appraise.