Abstract
BackgroundClinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes.Methods and FindingsWe conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling.ConclusionsImplementing clinically integrated EBHC curricula requires institutional support, a critical mass of the right teachers and role models in the clinical setting combined with patience, persistence and pragmatism on the part of teachers.
Highlights
In many low and middle income countries, healthcare professionals and decision makers are often simultaneously challenged by a significant burden of infectious diseases, a rising epidemic of chronic diseases of lifestyle, and the on-going consequences of violence and injuries [1]
Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years
Learning is supported through partnerships between various types of staff including the core evidence-based healthcare (EBHC) team, clinical lecturers and clinicians working in the clinical setting
Summary
In many low and middle income countries, healthcare professionals and decision makers are often simultaneously challenged by a significant burden of infectious diseases, a rising epidemic of chronic diseases of lifestyle, and the on-going consequences of violence and injuries [1] This creates the need for enhancing human, health systems and research capacity to address the prevention and management of multiple conditions [2], and to ensure that scarce resources are used effectively and efficiently [3, 4]. Findings from an overview of systematic reviews on the effects of EBHC teaching and learning approaches [10] and a recent randomised trial [11] show that clinically integrated teaching and learning strategies, with assessment, are the best options for improving EBHC knowledge, skills and attitudes. Integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes
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