EBM Skills Research Articles

Perceptions, knowledge, and perceived barriers to practicing evidence‐based medicine among pharmacists in Japanese community hospitals: A cross‐sectional multicenter survey

AbstractIntroductionEvidence‐based medicine (EBM) skills are required for pharmacists. However, the current status of EBM skills and its education in Japanese pharmacists remains unknown.ObjectivesWe investigated the perceptions, knowledge, and barriers for EBM in Japanese pharmacists.MethodsWe conducted a cross‐sectional survey of pharmacists employed by four community hospitals in Japan. A questionnaire including 55 questions to evaluate pharmacists' perceptions, knowledge, exposure, access, terminology, and barriers for EBM was developed based on our previous research.ResultsThe questionnaire was provided to 70 pharmacists and the response rate was 90% (n = 63). Regarding the 5As (Ask, Acquire, Appraise, Apply, Assess) skills, only 30.2% of pharmacists were confident in their skills for Ask, 17.5% for Acquire, 19.0% for Appraise, 34.9% for Apply, and 25.4% for Assess. Additionally, although less than 20% of pharmacists felt comfortable teaching EBM to pharmacy residents and were confident to explain to others any EBM‐related terms, more than 90% of the pharmacists recognized the importance of EBM education for patient care. Furthermore, they reported many barriers to EBM, such as skills, statistical knowledge, training, English, and opportunities to practice EBM.ConclusionAlthough most Japanese pharmacists in this study were not confident in their EBM skills and in teaching them, they acknowledged the importance of EBM. Our study suggests that providing EBM training, and the clinical roles and responsibilities could address the identified barriers, such as, lack of skills, knowledge, and opportunities to practice EBM, and pharmacists could better embrace EBM in their practice to optimize patient care.

11. ENHANCING EVIDENCE-BASED MEDICINE COMPETENCE IN THIRD-YEAR STUDENTS THROUGH BASIC SCIENCE RESEARCH TRAINING: OUTCOMES AND FINDINGS

Background: In 2022, for the first time, the Faculty of Medicine, Dai Nam University applies scientific research methods to 3rd year medical students.
 Objective: To evaluate the impact of the Medical Scientific Research Methods module on medical students’ skills and knowledge.
 Methods: This pre-test post-test pilot study used a prospective descriptive exploratory method by non-probability convenience sampling of all people participating in the course “Medical science research methods,” which was compulsory for 3rd-year medical students, Faculty of Medicine, Dai Nam University, from August to December 2022. The study invited a total of 89 students from two classes to participate. At the beginning of the course, 82 students completed the survey, while 66 students responded to the second survey after completing the course.
 Result: This study demonstrated that an undergraduate research methods course had a meaningful impact on medical literature search behaviors, understanding of medical research terminology, and confidence in evidence-based medical practice among students. However, despite these positive results, the knowledge and skills of students in evidence-based medicine were limited.
 Conclusion: The scientific research methods course has significantly improved students’ EBM knowledge and skills, albeit with some limitations. However, this study highlights the need for continued training programs and practical experience in medical research to enhance further and maintain learners’ proficiency in EBM.

Knowledge and attitude toward evidence-based medicine and associated factors among health science students in Mettu University southwest Ethiopia: A cross-sectional study

IntroductionEvidence-based medicine (EBM) is “the process of systematically seeking, examining, evaluating, and utilizing current research findings as the basis for clinical decision-making by combining both individual clinical competence and client choice”. ObjectiveThis study aimed to assess the knowledge and attitude toward EBM and its associated factors among health science students in Mettu University. MethodsA cross-sectional survey was conducted using a random sample of health science students in Mettu University from November to December 2022. Multivariable logistic regression analyses were used to identify the factors associated with the knowledge and attitude toward EBM. Adjusted odds ratio (AOR) with 95% confidence interval and P ≤ 0.05 was used to quantify strength of association between variables. ResultsOut of 423 health science students 415 completed the questionnaire (with a 98.1% response rate). Overall, 49.4% (205/415) of respondents had a favorable attitude toward EBM and 50.6% (208/415) had good knowledge of EBM. The majority 61.1% (253/415) of participants had internet access. Only 12.0% (50/415) of respondents had received EBM-related training. Respondent's EBM training was associated with knowledge of EBM were 2.7 times (AOR 2.70, 95% CI 1.38, 5.31), those who understood sensitivity were 3.0 times (AOR 3.09, 95% CI 1.76, 3 0.60), those who understood odds ratio were 2.0 times (AOR 2.08, 95% CI 1.35, 2.38), Aware of PubMed were 1.9 times (AOR 1.96, 95% CI 1.03, 3.73), and Owned smart-phone or PC were 3.6 times (AOR 3.67, 95% CI 3.20, 4.31). Good EBM knowledge was 3.0 times (AOR 3.01, 95% CI 2.05, 3.12), Aware of PubMed resources to make clinical decisions was 2.9 times (AOR 2.99, 95% CI 3.20, 3.61), and Participants owned a smartphone or personal computer were 3.2 times (AOR 3.23, 95% CI 3.05, 3.57) were predictors of positive attitude. ConclusionsThis study demonstrates a lack of formal EBM training and awareness of basic concepts of EBM among health science students. Health science students' attitude toward EBM were 49.4% to enhance EBM knowledge and skills, formal teaching of EBM courses should be integrated into medical education.

The First Asynchronous Online Evidence-Based Medicine Course for Syrian Health Workforce: Effectiveness and Feasibility Pilot Study.

Evidence-based medicine (EBM) is critical for providing the best scientifically proven patient health care, and it is implemented worldwide in order to improve the quality of the delivered health care. However, not all Syrian health professionals are knowledgeable about the importance, methodology, and implementation of EBM. Providing web-based learning courses on EBM might be effective in improving the EBM knowledge of health care professionals. This study was performed to test the effectiveness and the feasibility of an asynchronous web-based course on EBM in improving the competencies of Syrian health care professionals in terms of EBM. A web-based course on EBM was developed in Arabic and uploaded onto the Syrian Virtual University platform. An electronic registration form was designed and distributed to medical groups on social media for registration to this web-based course. Both the pretest and posttest had the same 3 sections to measure the impact of this web-based EBM program on the knowledge, skills, and attitudes of the Syrian health care professionals. The posttest had an additional section for measuring the efficacy and ease of use of this program. Student paired 1-tailed t test was used to analyze the differences in the different assessment sections among the participants. Nineteen participants filled the electronic registration form, but 8 participants did not meet the inclusion criteria. Therefore, the pretest was sent to the remaining 11 participants (7 men and 4 women) who graduated from Syrian universities. Ten of them completed the pretest, while 7 of them completed the posttest. The web-based course was found to be effective in improving the participants' EBM knowledge, skills, and attitudes at P>.05. Further, the web-based EBM course was feasible and easy-to-use. In order for EBM to be implemented in Syria, continuous medical education training programs should be designed for clinical practitioners. Our study shows that asynchronous web-based medical education is an effective and a feasible means for introducing the concept of EBM, improving practitioners' skills, and promoting the positive attitudes of Syrian clinical practitioners toward EBM.

Multisite assessment of emergency medicine resident knowledge of evidence-based medicine as measured by the Fresno Test of Evidence-Based Medicine.

Evidence-based medicine (EBM) is the application of scientific evidence while treating a patient. To date, however, there is very little evidence describing how residents in emergency medicine understand and incorporate EBM into practice. The aim of this study was to determine EBM theoretical and quantitative knowledge in emergency medicine residents in community hospital-based training programs. A sample of emergency medicine residents from nine hospitals was enrolled to complete a cross-sectional assessment of EBM skills from April 2021 through June 2021. Performance on the Fresno Test of Evidence-Based Medicine (FTEBM) was assessed utilizing descriptive statistics, t tests, and one-way analysis of variance. A total of 50.8% (124/244) of current emergency medicine residents completed the FTEBM during the study period. No significant difference on FTEBM scores was noted between the different types of medical degrees (DO vs. MD) (p=0.511), holding an advanced research degree (p=0.117), or between each postgraduate year of training (p=0.356). The mean score of those residents who rated their knowledge of EBM as average or higher was 36.0% (32.8-39.1%). The mean score of those residents who rated their programs as having an "average" or higher institutional focus on EBM was 34.9% (32.2-37.6%). Participating emergency medicine residents show an incomplete understanding of EBM both in theory and applied computations despite rating themselves as having an average understanding. Emergency medicine residencies would be well suited to implement a standardized EBM curriculum that focuses on longitudinal reinforcement of key concepts needed for the practicing physician.

Self-reported knowledge, attitudes, practices and barriers in use of evidence-based medicine among resident physicians in Kenya: a mixed methods study

BackgroundEvidence based medicine (EBM) helps clinicians to integrate latest research evidence into their daily clinical practice. There is a need for all healthcare professions to adopt it in order to provide safe and most cost-effective care. Postgraduate doctors are at the frontline of healthcare delivery and all medical institutions should strive to produce practitioners of EBM. Studies have shown that physicians are still struggling to adapt to this paradigm shift in the practice of medicine but very few studies have been done in Sub Saharan Africa. This study explored the self-reported knowledge, attitudes, practices and barriers of evidence-based practice among resident physicians in a tertiary teaching hospital.MethodsA mixed methods cross-sectional study that used convergent parallel design was conducted. The quantitative arm was conducted among all residents enrolled in the Master of Medicine programme at Aga Khan University Hospital Nairobi (AKUHN). It included an online survey exploring self-reported knowledge, attitudes, practices and barriers of EBM among all residents. Simultaneously, semi-structured In-Depth Interviews were carried out among 18 purposefully selected residents in order to explore the same themes in more depth.ResultsOne hundred and one residents (99%) responded to the survey. The mean scores for self-reported knowledge, attitude and practice of EBM among residents were 73.88, 66.96 and 63.19% respectively, which were generally higher than in comparable studies. There was a significant association between year of residency and practice of EBM. The most common barriers faced by residents were lack of time, lack of EBM skills and patients’ unawareness about EBM.From the qualitative study, residents demonstrated good knowledge and support of EBM but practice remained relatively poor. Barriers to EBM were characterized by lack of motivation, time, skills and resources, patient overload and fear of challenging consultants.ConclusionThere was good understanding and support of EBM among residents at AKUHN, though challenges were experienced in regards to practice of EBM because of lack of time and skills. Therefore resources should be allocated towards integrating EBM into undergraduate medical curricula to cultivate critical thinking skills at an early stage before transition into residency.

Online training in evidence-based medicine and research methods for GP registrars: a mixed-methods evaluation of engagement and impact

BackgroundEvidence-based medicine (EBM) is a core skillset for enhancing the quality and safety of patients’ care. Online EBM education could improve clinicians’ skills in EBM, particularly when it is conducted during vocational training. There are limited studies on the impact of online EBM training on clinical practice among general practitioner (GP) registrars (trainees in specialist general practice). We aimed to describe and evaluate the acceptability, utility, satisfaction and applicability of the GP registrars experience with the online course. The course was developed by content-matter experts with educational designers to encompass effective teaching methods (e.g. it was interactive and used multiple teaching methods).MethodsMixed-method data collection was conducted after individual registrars’ completion of the course. The course comprised six modules that aimed to increase knowledge of research methods and application of EBM skills to everyday practice. GP registrars who completed the online course during 2016–2020 were invited to complete an online survey about their experience and satisfaction with the course. Those who completed the course within the six months prior to data collection were invited to participate in semi-structured phone interviews about their experience with the course and the impact of the course on clinical practice. A thematic analysis approach was used to analyse the data from qualitative interviews.ResultsThe data showed the registrars were generally positive towards the course and the concept of EBM. They stated that the course improved their confidence, knowledge, and skills and consequently impacted their practice. The students perceived the course increased their understanding of EBM with a Cohen’s d of 1.6. Registrars identified factors that influenced the impact of the course. Of those, some were GP-related including their perception of EBM, and being comfortable with what they already learnt; some were work-place related such as time, the influence of supervisors, access to resources; and one was related to patient preferences.ConclusionsThis study showed that GP registrars who attended the online course reported that it improved their knowledge, confidence, skill and practice of EBM over the period of three months. The study highlights the supervisor’s role on GP registrars’ ability in translating the EBM skills learnt in to practice and suggests exploring the effect of EBM training for supervisors.

1449Rapid Evidence for Practice modules: using team-based learning to teach evidence-based medicine

Abstract Background Evidence-based medicine (EBM) teaching in medical education programs introduces key clinical epidemiology concepts to the future medical workforce. Team-based learning (TBL) is a student-centred learning strategy increasingly used in medical education. We adapted the TBL framework into Rapid Evidence for Practice (REP) modules which will provide students with EBM knowledge and skills and prepare them to apply evidence within short timeframes, simulating real world clinical contexts. Methods Year 2 graduate medical students completed a REP module on randomised controlled trials (RCTs) comprising: online informational content, an individual readiness quiz; a forum featuring a critical appraisal demonstration, and a team-based rapid appraisal and application of a published RCT to a clinical scenario. Student feedback was collected by questionnaire, using closed and open-ended items. Data will be analysed using descriptive statistics and thematic analysis. Results In total, 54/259 (20%) of participants completed a questionnaire regarding the REP module. Summary quantitative results found 91% of students agreed that REP helped them develop a way to use evidence to approach clinical questions and 81% agreed they were satisfied with this method of teaching. Complete quantitative and qualitative analysis results will be presented at the congress. Conclusions Our adaption of the TBL framework into a REP module addressing RCTs was highly rated by medical students. Further evaluation of REP for other study types is planned. Key messages REP appears to be an acceptable method of delivering EBM teaching to graduate medical students.

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

BackgroundEvidence-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.ObjectiveThis study aimed to assess the knowledge and attitudes toward EBM and its associated factors among medical interns in teaching hospitals.MethodsA 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.ResultsOut 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.ConclusionsThis 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.

Evidence-based medicine curricula and barriers for physicians in training: a scoping review.

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.

Analysing the literature: A research primer for low- and middle-income countries.

Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency medicine research. An emerging array of Free Online Open Access medical education (FOAMed) resources also provide opportunities to observe Evidence-based medicine critical appraisal in written or audio format and to actively participate as a learner. This chapter will highlight accessible resources that provide both methodological background and virtual mentoring for readers to develop EBM skills.

A prospective mixed-methods study evaluating the integration of an evidence based medicine curriculum into an internal medicine residency program.

IntroductionEvidence based medicine (EBM) skills are often lacking in the general internal medicine physician population. Our aim is to evaluate the impact of our internal medicine EBM curriculum on the residents’ EBM skills and knowledge through mixed methods.MethodsA prospective study was performed that evaluated the EBM curriculum: quantitatively, with pre/posttests and qualitatively through a focus group that addressed residents’ opinion on the educational and clinical impact of each aspect of the curriculum.ResultsA total of 60 internal medicine residents were surveyed. Short-term EBM skills: therapy workshops (N=25) median pretest score of 8 (IQR): [6–9]) vs posttest 8 (IQR: [8–9]), (p=0.006); diagnosis (N=16) pretest score of 6 (IQR: [3–6]) vs posttest 7 (IQR: [6–9]), (p=0.006); systematic review (N=13) pretest score of 4 (IQR: [4–6]) vs posttest 7 (IQR: [6–8]), (p=0.002); and harm (N=16) pretest score of 6 (IQR: [5–7]) vs posttest 7 (IQR: [7–8]), (p=0.004). Long-term EBM skills: Fresno test of competence in EBM, pretest median score of 110.5/212 (IQR: 96.0–124.0) and a median posttest score of 115/212 (IQR: 100.0–130.0) (p=0.60). Having previous EBM training, being actively involved in research and being the first author on a publication was associated with higher Fresno test scores. Focus group provided qualitative feedback on the residents’ EBM curriculum perception.ConclusionThis curriculum adds a significant contribution to the current field of medical education as it fills an important educational gap, through defining ways of effectively delivering EBM concepts which led to improvement in residents’ ability to evaluate and apply medical literature. The EBM curriculum was overall well received by the residents.

PHP304 - INTRODUCTION OF EBM IN MEDICAL PROFESSIONALS' EDUCATION IN BULGARIA, IN ASSOCIATION WITH THE HTA PROCESS - A PILOT STUDY

EBM incorporation in medical schools education provides essential tools for students, and future medical professionals in many directions such as staying current with medical literature, develop their skills in critical appraise in new research and innovations as well as in the HTA process. HTA is a multidisciplinary evidence based process and EBM skills will be valuable tools to inform the policy decision makers, always considering patient values and preferences. The objective of this paper is to emphasize the necessity and importance of integrating EBM in medical curriculum in order to improve the quality of the education, and HTA process. One hundred and seventy two (172) practicing medical professionals and students were voluntarily participated in this pilot study. A paper questionnaire was used for collecting data. In this paper we partially demonstrate the results. Completed questionnaires were received from 123 medical professionals and 49 students. Of the respondents 57% were familiar with the term EBM, although only 32% were familiar with the definition of HTA. According to 34% of the respondents EBM improves the HTA process, 6% do not think so and 60% cannot evaluate. From data collected 48% of the participants believe that reducing health care costs is directly related to the application and understanding of EBM, 12% do not believe so and 41% cannot evaluate. The majority of them, 59% support the necessity of incorporating EBM in their medical education, 9% do not support, and 32% cannot evaluate. The distribution of responses show 71% of the responders would have further training (qualification, specialization) in order to successfully apply the EBM in their daily work. The study is on going. Data from this pilot study confirmed the necessity of incorporating EBM in medical education curriculum, as it will be helpful to the process of HTA.

A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process

BackgroundEvidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM.MethodsWe synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice.ResultsA simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one’s approach towards EBM itself, and to the influences on decision-making; (2) pragmatism – in one’s approach to finding and evaluating evidence; and (3) knowledge of the patient – as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work.ConclusionWe have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.

A Cross-Sectional Study of Medical Student Knowledge of Evidence-Based Medicine as Measured by the Fresno Test of Evidence-Based Medicine

BackgroundEvidence-based medicine (EBM) has been included in the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Emergency Medicine (ABEM) milestones project as a required component during emergency medicine (EM) residency training. Milestone Level One states that graduating medical students must be able to “describe basic principles of EBM.” ObjectiveWe sought to identify the EBM skills of third- and fourth-year medical students. MethodsOur institution, a network with 17 different residencies, hosts U.S. osteopathic and allopathic medical students. As a part of orientation, students are required to complete an entry Fresno Test of EBM (FTEBM). Retrospectively, medical student FTEBM scores from 2011 were assessed using descriptive statistics. ResultsFour hundred seventeen FTEBM scores were analyzed. Participants represented 40 medical schools, including 17 allopathic (MD) and 23 osteopathic (DO) schools. Fifty percent of participants (n = 210) were female, and 51.6% (n = 215) were from a DO medical school. Overall mean performance for the FTEBM was 47.2%. Exploring the results by individual question were (individual EBM question topics are in parentheses): 1A (study question), 62.0%; 1B (study question), 64.4%: 2 (sources of evidence), 67.6%; 3 (study design), 57.1%; 4 (search strategies), 53.2%; 5 (relevance), 41.2%; 6 (internal validity), 43.6%; 7 (magnitude), 37.8%; 8 (two-by-two grids), 30.0%; 9 (number needed to treat), 16.9%; 10 (confidence intervals), 34.3%; 11 (diagnosis), 5.0%; and 12 (prognosis), 43.4%. ConclusionsAs measured by the FTEBM, senior medical students demonstrate understanding of about half of EBM. EM residencies can anticipate the need to instruct their residents in EBM concepts in order to meet ACGME/ABEM milestone requirements.

Using standardized patients to evaluate medical students' evidence-based medicine skills.

To analyze the effectiveness of an Evidence Based Medicine Objective Structured Clinical Examination (EBM OSCE) with standardized patients for end of third year medical students at our institution. This was a single-center prospective cross-sectional investigation. As part of the eight-station OSCE exam, the authors developed and implemented a new 25-minute EBM OSCE station with the goal of evaluating evidence based medicine skills necessary for daily clinical encounters. The OSCE case involved a highly educated patient with a history of recurrent debilitating migraines who has brought eight specific questions regarding the use of steroids for migraine headaches. Students were provided computer stations equipped to record a log of the searches performed. One hundred and four third-year medical students participated in this study. The average number of search tools used by the students was 4 (SD = 2). The 104 students performed a total of 896 searches. The two most commonly used websites were uptodate.com and google.com. Sixty-nine percent (95% CI, 60% to 78%) of students were able to find a meta-analysis regarding the use of dexamethasone for the prevention of rebound migraines. Fifty-two percent of students were able to explain that patients who took dexamethasone had a moderate RR (0.68 to 0.78) of having a recurrent migraine, and 71% of students were able to explain to the standardized patient that the NNT for dexamethasone was nine. The EBM OSCE was successfully integrated into the existing eight-station OSCE and was able to assess student EBM skills.

Validation of the Colorado Psychiatry Evidence-Based Medicine Test

Evidence-based medicine (EBM) has become an important part of residency education, yet many EBM curricula lack a valid and standardized tool to identify learners' prior knowledge and assess progress. We developed an EBM examination in psychiatry to measure our effectiveness in teaching comprehensive EBM to residents. We developed a psychiatry EBM test using the validated EBM Fresno Test of Competence for family medicine. The test consists of case scenarios with open-ended questions. We also developed a scoring rubric and obtained reliability with multiple raters. Fifty-seven residents provided test data after completing 3, 6, 25, or 31 EBM sessions. The number of sessions for each resident was based on their length of training in our program. The examination had strong interrater reliability, internal reliability, and item discrimination. Many residents showed significant improvement on their examination scores when data were compared from tests taken before and after a sequence of teaching sessions. Also, a threshold for the level of expert on the examination was established using test data from 5 EBM teacher-experts. We successfully developed a valid and reliable EBM examination for use with psychiatry residents to measure essential EBM skills as part of a larger project to encourage EBM practice for residents in routine patient care. The test provides information on residents' knowledge in EBM from entry level concepts through expert performance. It can be used to place incoming residents in appropriate levels of an EBM curriculum and to monitor the effectiveness of EBM instruction.

Assessment of Pediatric Resident Knowledge and Skills in Evidence-Based Medicine

Our objective was to validate an EBM assessment instrument, originally developed by Chernick et al. as a measure of baseline EBM knowledge and skills prior to significant changes to our curriculum.

Innovation in evidence-based medicine education and assessment: an interactive class for third- and fourth-year medical students

INTRODUCTIONEvidence-based medicine (EBM) is an importantcomponent of an undergraduate medical educationcurriculum that promotes lifelong learning andcritical thinking [1]. Defined as ‘‘the conscientious,explicit, and judicious use of current best evidence inmaking decisions about the care of individualpatients’’ [2], EBM can be considered another impor-tant clinical tool, not unlike the stethoscope. Theauthors designed and assessed an innovative EBMcourse for third-year medical students to strengthenthe EBM curriculum for undergraduate medicaleducation.BACKGROUNDPrevious studies have advocated real-time teaching ofEBM during attending rounds, in a case-based formatwith role playing or with standardized patients [3–5].At the same time, brief training in literature searchingand critical appraisal skills has been shown to beeffective, and interactive workshops have beensuggested as an ideal format for medical students[6–8]. At many academic medical centers, includingthe authors’, constraints on resident and student dutyhours and increased demands for productivity fromclinical teaching faculty have made adding formalcurricula to the clinical services problematic. In aneffort to combine an interactive learning environmentwith core topics in EBM, we devised a multidisciplin-ary, case-based seminar series that is team-taughtby clinicians and a librarian and is designed to beinteractive, engaging, and clinically relevant.METHODSDesigned by a medical librarian and a physician(Schardt and Gagliardi), the EBM course is intendedto provide an interactive forum for students todevelop skills in practicing EBM in the care ofpatients. The first version of the EBM course wasoffered as a noncredit elective to 8 third-year medicalstudents in 2006 and consisted of 6 90-minute sessionsconducted over the course of the spring semester.After experimenting with a 10-session format, wesettled on 6 120-minute sessions conducted onconsecutive Thursday evenings, from 5:00 p.m. to7:00 p.m.After the third iteration of the course in 2008, itbecame a credit-bearing elective, which requiredopening it not only to third-year medical students,but also to fourth-year medical students. Since the2008/09 academic year, the EBM course has attractedapproximately forty students per year. The currentstudy with pre- and post-course assessments ofknowledge as well as attitudes was conducted duringthe 2008/09 academic year.The EBM course is designed to optimize studentreadiness and participation, faculty willingness toteach, and instructional strategies to maximize reten-tion and use of EBM skills, with key features outlinedbelow.1. Timing in the curriculumAt our institution, medical students complete theirrequired clinical clerkships during the second year.The EBM course is designed for students who arepursuing academic endeavors during the third year,which is dedicated to research. This is optimal timingbecause students have completed their requiredclinical clerkships and, therefore, have had somepatient care experience along with the opportunity toobserve and practice EBM in a variety of settings.Additionally, as they are about halfway through theirscholarly research activity year, they are cognizant ofsome of the logistical and practical issues involved indesigning and conducting scientific research.2. Course organization and facultyTable 1 shows the course outline. The introductorysession provides an overview of the EBM frameworkand the basics of study design. The subsequent foursessions are case based and teach relevant issuespertaining to the retrieval, appraisal, and applicationof studies of therapy, diagnosis, harm, and systematicreviews. The final session is designed to demonstratethe real-time application of EBM skills. Cliniciansfrom the emergency department and in-patient unitstake students through actual clinical cases they haveencountered and demonstrate how they used EBM tocontribute to their care of actual patients. Each caseusually takes five to fifteen minutes and effectivelydemonstrates that EBM can be incorporated intoclinical practice.We rely on a diverse faculty with a broad spectrumof clinical interest and experience. Facilitators areclinically based and recruited from departments anddisciplines in which they are likely to have encoun-tered many of the students in clinical settings. Inthis way, no one faculty member is responsible fordelivering of all content, students benefit fromwitnessing the use of EBM skills by a variety of

Japanese Resident Physicians' Attitudes, knowledge, and Perceived Barriers on the Practice of Evidence Based Medicine: a Survey.

BackgroundEvidence based medicine plays a crucial role as a tool that helps integrate research evidence into clinical practice. However, few reports have yet to examine its application in daily practice among resident physicians in Japan. The aim of this study was to assess the attitudes towards and knowledge of EBM among resident physicians in Japanese and determine perceived barriers to its use.FindingsA cross-sectional, self-administered anonymous questionnaire was distributed to 60 resident staffs at Saga University Hospital in Japan.Forty residents completed and returned the questionnaire. Fifty four percent of respondents understood the basic terminology of EBM, 3% could explain this to others, and 41% indicated they would like to understand the terminology more. Thirteen percent admitted having a good understanding of EBM basic skills. Fifty respondents indicated having read EBM sources, but only 3% indicated that they use these sources in clinical decision making. The most prominent barriers of EBM application revealed in this study were insufficient time to access the sources, a lack of native language references, and insufficient basic EBM skills, but not scepticism about the EBM concept.ConclusionsIn general, respondents positively welcomed EBM, and moderately understood and knew basic EBM skill; however, barriers in its application were shown to exist.