Evidence-based Medicine Content Research Articles

The research escape hunt: An escape room-scavenger hunt for resident education.

Research and evidence-based medicine (EBM) education are important elements of emergency medicine (EM) residency training; however, curricular time is limited and integrating novel strategies to engage learners and improve understanding of complex concepts is challenging. We sought to develop a unique research escape hunt educational experience to teach EM residents basic research and EBM skills using an active-learning, team-based strategy. A nine-station escape room-scavenger hunt was designed around educational content including (1) predictive statistics and diagnostic test characteristics, (2) interpretation of data and statistical analysis, (3) study design, (4) informed consent for research, and (5) the ethical principles guiding research. Stations required participants to use a variety of strategies to solve puzzles, with a correct response required to progress through the escape hunt. Teams worked together to solve each station's puzzles, with opportunities to reinforce the content in real time. Subsequent sessions were presented in a virtual format using Zoom breakout rooms over the past 2 years. Postactivity assessments were grounded in Kirkpatrick's model and focused on participants' reactions, learning, and behavior. Participants reported high levels of satisfaction (100% [21/21] "satisfied" or "extremely satisfied") and engagement (95% [20/21] "engaged" or "very engaged") with the activity, as well as increased comfort with the research and EBM concepts covered (91% [19/21] "agree" or "strongly agree" increased comfort), and demonstrated improvements in knowledge across each content area presented (91% [19/21]). This practical, team-based curriculum was found to be a successful way to engage residents with research methodology and EBM content. This curriculum is feasible for both in-person and virtual formats and we will continue to use this as a component of our EM residency program moving forward.

Integrating Information Literacy and Evidence-Based Medicine Content within a New School of Medicine Curriculum: Process and Outcome

ABSTRACTThis column describes a process for integrating information literacy (IL) and evidence-based medicine (EBM) content within a new school of medicine curriculum. The project was a collaborative effort among health sciences librarians, curriculum deans, directors, and faculty. The health sciences librarians became members of the curriculum committees, developed a successful proposal for IL and EBM content within the curriculum, and were invited to become course instructors for Analytics in Medicine. As course instructors, the librarians worked with the other faculty instructors to design and deliver active learning class sessions based on a flipped classroom approach using a proprietary Information Mastery curriculum. Results of this collaboration may add to the knowledge base of attitudes and skills needed to practice as full faculty partners in curricular design and instruction.

Evidence-based medicine skills that last: A transferable model utilizing integration, spaced learning, and repetition with a single study design among second-year medical students

This article was migrated. The article was marked as recommended. Introduction. The medical education literature lacks descriptions of evidence-based medicine (EBM) curricula with competency-based learning outcomes. The objective of this report is to describe an approach to designing, implementing, and assessing long-term learning in an integrated second-year EBM curriculum. Methods. Two complementary approaches were used. The primary deliberate approach incorporated large-group randomized controlled trial (RCT) critical appraisal sessions into existing organ system modules. The second approach added brief applications of EBM content to small-group case-based learning sessions. To assess learning, an open response written examination mapped to EBM competencies was administered at the beginning of the third year. Results. Data were available for 241 students. Using only walking knowledge, 47% of students at the beginning of the third year discussed two major weaknesses of an RCT; an additional 39% did so for only one. The ability to formulate a clinical question, describe elements of an appropriate search strategy and determine applicability to different patients was demonstrated by 84%, 87%, and 81% of examinees, respectively. Conclusion. This early work demonstrates that durable learning of EBM skills, including critical appraisal, is achievable among second-year medical students. Further work to improve learning in the second year and extend learning into subsequent years is forthcoming.

The evidence system of traditional Chinese medicine based on the Grades of Recommendations Assessment, Development and Evaluation framework.

Evidence-based medicine (EBM) originated in the 1990s (1). It has become the current development trend and direction of clinical medicine. Decision-making in medicine must be based on the current best evidence, which is the key point of EBM, has been accepted by more and more people (2). “Evidence” is the key and core of EBM, while after nearly 20 years of development, the classical definition of evidence can not summarize the whole content of EBM (3,4). If we do not establish an evidence focused system, it will cause the misunderstanding and misuse of EBM (5,6), and will be a large drag on the development of EBM.

La Medicina Basada en Evidencias como un Nuevo Paradigma de la Enseñanza y la Práctica de la Medicina

Se presenta una revisión crítica de esta nueva propuesta de enseñanza y práctica de la medicina. Se empieza con una breve consideración del escenario en el que se desenvuelve la medicina actual. A continuación se describe el contenido de la medicina basada en evidencias, poniendo énfasis en los componentes de evidencia externa, pericia clínica y preferencias de los pacientes. Se hace luego un recuento de sus aplicaciones en la medicina clínica y en la salud pública. Finalmente se indica las ventajas que ofrece y sus potenciales riesgos y limitaciones. La Medicina Basada en Evidencias es una propuesta novedosa que plantea una saludable subversión en la medicina, en tanto promueve el escepticismo racional de los médicos, que para tomar una decisión con respecto a sus pacientes, deberían basarse ya no en el consejo de venerables expertos, sino en una combinación de la mejor evidencia externa disponible, de su propia pericia clínica y de la opinión del paciente.

Methods of teaching medical trainees evidence-based medicine: a systematic review

The principles of evidence-based medicine (EBM) provide clinicians with the ability to identify, source, appraise and integrate research evidence into medical decision making. Despite the mantra of EBM encouraging the use of evidence to inform practice, there appears little evidence available on how best to teach EBM to medical trainees. A systematic review was performed to identify what type of educational method is most effective at increasing medical trainees' competency in EBM. A systematic review of randomised controlled trials (RCTs) was performed. Electronic searches were performed across three databases. Two reviewers independently searched, extracted and reviewed the articles. The quality of each study was assessed using the Cochrane Collaboration's risk of bias assessment tool. In total, 177 citations were returned, from which 14 studies were RCTs and examined for full text. Nine of the studies met the inclusion criteria and were included in this review. Learner competency in EBM increased post-intervention across all studies. However, no difference in learner outcomes was identified across a variety of educational modes, including lecture versus online, direct versus self-directed, multidisciplinary versus discipline-specific groups, lecture versus active small group facilitated learning. The body of evidence available to guide educators on how to teach EBM to medical trainees is small, albeit of a good quality. The major limitation in assessing risk of bias was the inability to blind participants to an educational intervention and lack of clarity regarding certain aspects within studies. Further evidence, and transparency in design, is required to guide the development and implementation of educational strategies in EBM, including modes of teaching and the timing of delivering EBM content within the broader medical curriculum. Further research is required to determine the effects of timing, content and length of EBM courses and teaching methods.

The status of evidence-based medicine education in urology residency

Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of the current best evidence in decision-making for the care of patients. Teaching best evidence practice in residency should include both formal or freestanding content, as well as integration into clinical scenarios and patient care. We sought to assess the attitudes, experience and knowledge of EBM in urology residency training across Canada. An anonymous, cross-sectional, self-report questionnaire was completed by a convenience sample of 29 residents, including all chief urology residents in English-speaking programs across Canada. The survey included both open-ended and closed-ended questions designed to assess familiarity and attitudes towards EBM and potential barriers to developing EBM skills in a surgical training program. Questions were formatted to determine the understanding of statistical and analytical concepts, as well as familiarity of available EBM resources. Descriptive and correlative statistics were used to analyze the responses. The response rate was 100%. An overwhelming majority of residents felt that EBM is an important component of the urology residency and journal club was the most common vehicle for discussing best evidence concepts. However, there was significant variation in the presence of freestanding, formal curricula across programs, with only 28% of residents signifying that they received any formal training in their program. The apparent level of understanding of important EBM terminology and resources appears to be limited. The most frequently stated barriers to incorporating EBM curricula into urology training were time constraints and a perceived lack of expert educators. This self-report survey of urology chief residents identified the overwhelming acceptance of the importance of EBM in their training. Although best evidence practices appears to be addressed in journal clubs and in real-life clinical experiences, the obvious lack of familiarity and understanding of EBM content and resources would suggest a need for redoubling efforts to ensure appropriate exposure and instruction in our training programs.

Development, implementation, and outcomes of an initiative to integrate evidence-based medicine into an osteopathic curriculum.

In response to the American Osteopathic Association's Commission on Osteopathic College Accreditation (COCA) standards set forth in 2008, osteopathic medical schools are restructuring curricula to demonstrate they are teaching the seven core competencies and integrating evidence-based medicine (EBM) throughout all 4 years of training. To describe and evaluate the efforts of a college of osteopathic medicine to integrate EBM concepts into its curriculum while maintaining existing course content and faculty contact hours. One-group pre- and posttest study. Kirksville College of Osteopathic Medicine-A.T. Still University (KCOM) in Missouri. KCOM course directors in workshop series I (n=20) and KCOM faculty workshop series II (n=14). A faculty development workshop series based on the diffusion of innovations model was instituted to facilitate cultural change, gain faculty support, and accelerate the implementation of EBM throughout KCOM's curriculum. Faculty attitudes, confidence levels, and the number of courses that included instruction of EBM concepts were measured in August 2007 and May 2008. Faculty attitudes about integrating EBM into the curriculum and confidence levels measured pre- and postworkshop series found that 21 of 26 participants believed they improved their ability to locate primary EBM resources using the Internet; 21 of 28 improved their ability to teach EBM concepts to students. Fifteen of 16 faculty course directors agreed to find ways to incorporate EBM into their classes. Review of KCOM's course syllabi in April 2009 demonstrated a statistically significant difference (P<.001) in the number of faculty teaching EBM concepts after the faculty development workshop series concluded in March 2008 compared to before the series commenced in March 2006. An unexpected outcome was the implementation of a faculty-conceived, standalone EBM course in fall 2007. A workshop series based on the diffusion of innovations model is effective in garnering faculty support for the implementation of a change in curriculum that emphasizes EBM content without increasing faculty contact hours or eliminating existing curricular content. A faculty development model emphasizing a "bottom-to-top" approach is effective in achieving workplace culture changes and seamless curricular transitions. Results have shown that a consensus building model is conducive to engaging faculty and garnering its support to effect curricular change, which, ultimately, ensures success.

The Vanguard Faculty Program: Research Training for Complementary and Alternative Medicine Faculty

The increasing use of complementary and alternative medicine (CAM) treatment is paralleled by a growing demand for an evidence-based approach to CAM practice. In 2007, the Helfgott Research Institute at the National College of Natural Medicine (NCNM), in partnership with Oregon Health & Science University (OHSU), both in Portland, OR, began a National Institutes of Health-funded initiative to increase the quality and quantity of evidence-based medicine (EBM) content in the curricula at NCNM. One key strategy of the Research in Complementary and Alternative Medicine Program (R-CAMP) initiative was to create a faculty development program that included four components: intensive training in EBM; professional skills enhancement; peer and mentored support; and, ultimately, utilization of these skills to incorporate EBM into the curricula. This initiative is centered on a core group of faculty at NCNM, called the Vanguard Faculty, who receives early, intensive training in EBM and works to incorporate this training into classes. Training consists of an intensive, week-long course, monthly group meetings, and periodic individualized meetings. Vanguard Faculty members also receive mentorship and access to resources to pursue individualized faculty development, research or scholarly activities. Early evaluations indicate that this effort has been successful in increasing EBM content in the curricula at NCNM. This article describes the Vanguard Faculty program in an effort to share the successes and challenges of implementing a wide-ranging faculty development and curricular initiative at a complementary and alternative medicine institution.

Where is the wisdom? I – A conceptual history of evidence‐based medicine

Rationale Evidence-based medicine (EBM) has been acclaimed as a major advance in medical science, but criticized as a proposed alternative model for the practice and teaching of medicine. Ambiguity regarding the proper role of the contributions of EBM within the fabric of medicine and health care has contributed to this discrepancy. Aims and objectives We undertook a critical review of the history of the EBM movement, beginning with its origins in the 1970s and continuing through this century. We drew upon the results of an independent project that rationalized the EBM domain from the perspective of educational evaluation and assessment. We considered the content of EBM in relationship to the propositions and promises embodied in advocacy publications. Results EBM emerged in the context of the explosion of biomedical information in the decade preceding public access to the Internet in the mid-1990s and drew upon the independently derived 'information literacy' formula developed by information scientists during the 1980s. The critically important content and achievements of EBM are fully explained within the confines of the information literacy model. The thesis that EBM offers an alternative paradigm for individualized health care, asserted in the advocacy literature, is not supported by published models of evidence-based clinical practice. Conclusion A critical historical review of the origins, content and development of the EBM movement proposes that full integration of the fruits of the movement into routine clinical care remains a conceptual and practical challenge.

Evidence-Based Medicine Is Not For Kids † 1913

Parents, payors and preceptors demand proof for what we do, but current, best evidence of efficacy for diagnostic and therapeutic manuevers is hard to come by. New reports appear daily - by the tens of thousands each year - but the busy clinician has little time, and often too few skills to evaluate them critically. A journal is now published by the American College of Physicians whose title [Evidence-Based Medicine(EBM)], editors [Haynes & Sackett], and statement of purpose [Vol 1,p 2] have promised valuable help by providing critical reviews with special focus on practical applications. We examined EBM's content for evidence of a selection bias against pediatric journals and pediatric content during its first year of publication. EBM abstracted and analyzed in detail 143 original articles from 35 peer-reviewed journals from 11/95 to 10/96. Of these, 98 [68.5%] were from 12 General-Medical [GM], 15[10.5%] from 8 Subspecialty-Medical [SM], 22 [15.4%] from 12 Other-Specialty[OS] and 8 [5.6%] from 3 Pediatric [P] journals. EBM abstracted another 7 articles on pediatric subjects,all from GM journals. Thus, < 6% of EBM abstracts were from P journals while almost half [7/15] of citations concerning pediatric topics were from GM journals. A total 17,558 original articles were published in the 35 journals reviewed by EBM as a source for their abstracts. Articles from the GM journals were three-times more likely to be abstracted and presented in detail [98/5,785 or 16.9/1,000] than those from the P journals [8/1,235 or 6.4/1,000; χ2=9.025, p=<0.005. This negative bias was equally evident for work from OS [22/5,488 or 4.0/1,000] and even from SM journals [15/5,050 or 3.0/1,000]. This bias was not explained by the proportion of clinical trials [CT], meta-analyses [MT], or practice guidelines [PG] between journals. The proportion [CT+MA+PG/total original articles] for the GM journals [738/5,785 or 12.8%] was similar to that for the OS [750/5,488 or 13.7%] and for the SM journals [700/5,050 or 13.9%]. In fact, the proportion was significantly higher for the P journals [230/1,235 or 18.6%; χ2=28.971, p<0.001. Yet, EBM abstracted articles four-times more commonly from GM [98/738 or 132.8/1,000 CT+MA+PG] than from P journals [8/230 or 34.8/1,000 CT+MA+PG; χ2=18.293, p<0.001]. Once again, this negative bias was also evident for work from the OS [22/750 or 29.3/1,000] and from the SM journals [15/700 or 21.4/1,000]. In summary, it is clear from these findings that the [unstated] purpose of EBM is to aid clinicians who engage in general medical practice. Those who practice other forms of primary care, specialty, or subspecialty medicine must look elsewhere for help.