Abstract
The authors conducted a survey examining (1) the current state of evidence-based medicine (EBM) curricula in US and Canadian medical schools and corresponding learning objectives, (2) medical educators' and librarians' participation in EBM training, and (3) barriers to EBM training. A survey instrument with thirty-four closed and open-ended questions was sent to curricular deans at US and Canadian medical schools. The survey sought information on enrollment and class size; EBM learning objectives, curricular activities, and assessment approaches by year of training; EBM faculty; EBM tools; barriers to implementing EBM curricula and possible ways to overcome them; and innovative approaches to EBM education. Both qualitative and quantitative methods were used for data analysis. Measurable learning objectives were categorized using Bloom's taxonomy. One hundred fifteen medical schools (77.2%) responded. Over half (53%) of the 900 reported learning objectives were measurable. Knowledge application was the predominant category from Bloom's categories. Most schools integrated EBM into other curricular activities; activities and formal assessment decreased significantly with advanced training. EBM faculty consisted primarily of clinicians, followed by basic scientists and librarians. Various EBM tools were used, with PubMed and the Cochrane database most frequently cited. Lack of time in curricula was rated the most significant barrier. National agreement on required EBM competencies was an extremely helpful factor. Few schools shared innovative approaches. Schools need help in overcoming barriers related to EBM curriculum development, implementation, and assessment. Findings can provide a starting point for discussion to develop a standardized competency framework.
Highlights
Evidence-based medicine (EBM) has been defined as ‘‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients [which involves] integrating individual clinical expertise with the best available external clinical evidence from systematic research’’ [1]
A 2002 study of EBM training in internal medicine clerkships found that 38.5% of the 109 responding US medical schools had a formal EBM curriculum during the third year and/or fourth year [2]
The measurable learning objectives included in the analysis described specific and observable EBM knowledge and skills that students were expected to attain (e.g., ‘‘Define evidence-based medicine (EBM) in one’s own words,’’ ‘‘Analyze population health data using appropriate measures’’)
Summary
Evidence-based medicine (EBM) has been defined as ‘‘the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients [which involves] integrating individual clinical expertise with the best available external clinical evidence from systematic research’’ [1]. It affects both patient outcomes and trainees’ practice-based learning and improvement [2, 3]. A 2002 study of EBM training in internal medicine clerkships found that 38.5% of the 109 responding US medical schools had a formal EBM curriculum during the third year and/or fourth year [2]. That study noted lack of time for student’s EBM training in the school curriculum and
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