Abstract
ObjectivesTo describe the published literature on EBM curricula for physicians in training and barriers during curriculum implementation. MethodsWe performed a systematic search and review of the medical literature on PubMed, Embase, ERIC, Scopus and Web of Science from the earliest available date until September 4, 2019. ResultsWe screened 9,042 references and included 29 full-text studies and 14 meeting abstracts. Eighteen studies had moderate validity, and 6 had high validity. The EBM curricular structure proved highly variable in between studies. The majority of the EBM curricula was longitudinal with different lengths. Only five studies reported using Kern's six-step approach for curriculum development. Twenty-one articles reported on EBM skills and knowledge, and only 5/29 full-text articles used a validated assessment tool. Time was the main barrier to EBM curriculum implementation. All the included studies and abstracts, independent of the EBM curriculum structure or evaluation method used, found an improvement in the residents' attitudes and/or EBM skills and knowledge. ConclusionsThe current body of literature available to guide educators in EBM curriculum development is enough to constitute a strong scaffold for developing any EBM curriculum. Given the amount of time and resources needed to develop and implement an EBM curriculum, it is very important to follow the curriculum development steps and use validated assessment tools.
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".1 EBM involves integrating clinical expertise with the best available evidence in an attempt to bridge the gap between the growing medical literature and patient care while considering the preferences and values of the patient in the decision-making.[2]
This review was guided by the question, 'What is the structure of the existent EBM curricula and its impact on the residents' attitudes, behaviors, skills and knowledge and what are the barriers identified during the EBM curriculum implementation process? Given the complexity of the research question, we decided that a scoping review would be the ideal study design to answer our question
The final review included 43 articles (29 full-text articles and 14 abstracts) describing the structure of the EBM curriculum. Thirteen of these articles reported on barriers to EBM curriculum implementation
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".1 EBM involves integrating clinical expertise with the best available evidence in an attempt to bridge the gap between the growing medical literature and patient care while considering the preferences and values of the patient in the decision-making.[2]. PICO, 2 tables, incidence and prevaformulate questions, gen- lence, representative descriperate searches, develop- tive statistic, standard deviaing searching strategies, tion and measures of high quality EBM revariability, multiple comparisources, information mas- sons, types of statistical tests, tery; essential EBM con- power and sample size calcucepts, including clinical lations, number needed to question development, harm/treat, confounding aslevels of evidence search sessment and adjustment, pastrategies, and appraisal tient safety and quality imtechniques; critically ap- provement methods, national praised topics - each CAT surgical quality improvement is structured to include the program, surgical care im-. Mastery of residents' evidence- Level of confidence in based medicine knowledge and basic EBM skills skills as well as their confidence at critically appraising medical literature and using evidence to inform clinical decisions.
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