Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial

BMC Medical Education

Alan Schwartz³  Steven M Downing³  Salvador Marín-Beltrán²  Luis F Kieffer-Escobar¹  Melchor Sánchez-Mendiola⁴ 

[1]Department of Biomedical Informatics, UNAM Faculty of Medicine, Mexico City, Mexico

[2]Department of Pediatrics, Central Military Hospital, Mexico city, Mexico

[3]Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

[4]Department of Medical Education, UNAM Faculty of Medicine, Mexico City, Mexico

关键词: Critical appraisal skills;    Educational assessment;    Curriculum development;    Undergraduate medical education;    Evidence-based medicine;   

Others  :  1153198
DOI  :  10.1186/1472-6920-12-107

 received in 2012-07-23, accepted in 2012-10-31,  发布年份 2012

【 摘 要 】

Background

Evidence-Based Medicine (EBM) is an important competency for the healthcare professional. Experimental evidence of EBM educational interventions from rigorous research studies is limited. The main objective of this study was to assess EBM learning (knowledge, attitudes and self-reported skills) in undergraduate medical students with a randomized controlled trial.

Methods

The educational intervention was a one-semester EBM course in the 5^th year of a public medical school in Mexico. The study design was an experimental parallel group randomized controlled trial for the main outcome measures in the 5^th year class (M5 EBM vs. M5 non-EBM groups), and quasi-experimental with static-groups comparisons for the 4^th year (M4, not yet exposed) and 6^th year (M6, exposed 6 months to a year earlier) groups. EBM attitudes, knowledge and self-reported skills were measured using Taylor’s questionnaire and a summative exam which comprised of a 100-item multiple-choice question (MCQ) test.

Results

289 Medical students were assessed: M5 EBM=48, M5 non-EBM=47, M4=87, and M6=107. There was a higher reported use of the Cochrane Library and secondary journals in the intervention group (M5 vs. M5 non-EBM). Critical appraisal skills and attitude scores were higher in the intervention group (M5) and in the group of students exposed to EBM instruction during the previous year (M6). The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group (p<0.001, Cohen's d=0.88 with Taylor's instrument and 3.54 with the 100-item MCQ test). M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups, but lower than the M5 EBM group.

Conclusions

Formal medical student training in EBM produced higher scores in attitudes, knowledge and self-reported critical appraisal skills compared with a randomized control group. Data from the concurrent groups add validity evidence to the study, but rigorous follow-up needs to be done to document retention of EBM abilities.

【 授权许可】

   
2012 Sánchez-Mendiola et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

【 参考文献 】

• [1]Straus SE, Glasziou P, Richardson WS, Haynes RB: Evidence-Based Medicine. How to Practice and Teach it. 4th edition. Philadelphia, PA: Elsevier Churchill Livingstone; 2011.
• [2]Institute of Medicine (US): Health Professions Education: A Bridge to Quality. Washington (DC): National Academies Press; 2003.
• [3]Whitcomb ME: Why we must teach evidence-based medicine. Acad Med 2005, 80:1-2.
• [4]Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J: Second International Conference of Evidence-Based Health Care Teachers and Developers. Sicily statement on evidence-based practice. BMC Med Educ 2005, 5(1):1. http://www.biomedcentral.com/1472-6920/5/1 webcite BioMed Central Full Text
• [5]Report from the World Federation on Medical Education: WFME Task Force on Defining International standards in basic medical education. Med Educ 2000, 34:665-75.
• [6]Dobbie AE, Schneider FD, Anderson AD, Littlefield J: What evidence supports teaching evidence-based medicine? Acad Med 2000, 75:1184-5.
• [7]Norman GR, Shannon SI: Effectiveness of instruction in critical appraisal (evidence-based medicine) skills: a critical appraisal. CMAJ 1998, 158:177-81.
• [8]Taylor R, Reeves B, Ewings P, Binns S, Keast J, Mears R: A systematic review of the effectiveness of critical appraisal skills training for clinicians. Med Educ 2000, 34:120-125.
• [9]Horsley T, Hyde C, Santesso N, Parkes J, Milne R, Stewart R: Teaching critical appraisal skills in healthcare settings. Cochrane Database of Systematic Reviews. The Cochrane Library, Issue 05, Art. No. CD001270
• [10]Coomarasamy A, Taylor R, Khan KS: A systematic review of postgraduate teaching in evidence-based medicine and critical appraisal. Med Teach 2003, 25:77-81.
• [11]Coomarasamy A, Khan KS: What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ 2004, 329:1017-1021.
• [12]Green ML: Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: a critical review of curricula. Acad Med 1999, 74:686-94.
• [13]Hatala R, Guyatt G: Evaluating the teaching of Evidence-based Medicine. JAMA 2002, 288:1110-2.
• [14]Flores-Mateo G, Argimon JM: Evidence based practice in postgraduate healthcare education: a systematic review. BMC Health Serv Res 2007, 7:119. BioMed Central Full Text
• [15]Pitkäla K, Mäntyranta T, Strandberg TE, Mäkelä M, Vanhanen H, Varonen H: Evidence-based medicine – how to teach critical scientific thinking to medical undergraduates. Med Teach 2000, 22:22-6.
• [16]Ghali WA, Saitz R, Eskew AH, Gupta M, Quan H, Hershman WY: Successful teaching in evidence-based medicine. Med Educ 2000, 34:18-22.
• [17]Burrows S, Moore K, Arriaga J, Paulaitis G, Lemkau HL: Developing an “Evidence-Based Medicine and Use of the Biomedical Literature” component as a longitudinal theme of an outcomes-based medical school curriculum: year 1. J Med Libr Assoc 2003, 91:34-41.
• [18]Barnett SH, Kaiser S, Morgan LK, Sullivant J, Siu A, Rose D: An integrated program for Evidence-based Medicine in medical school. Mt Sinai J Med 2000, 67:163-8.
• [19]Srinivasan M, Weiner M, Breitfled PP, Brahmi F, Dickerson KL, Weiner G: Early introduction of an evidence-based medicine course to preclinical medical students. J Gen Intern Med 2002, 17:58-65.
• [20]Elessi K, Mokhallalati M, Madbak S: Evidence-based medicine comes to Gaza. Lancet 2011, 378(9806):1834-5.
• [21]Sánchez-Mendiola M: Evidence-based medicine teaching in the Mexican Army Medical School. Med Teach 2004, 26(7):661-663.
• [22]Sánchez-Mendiola M: La Medicina Basada en Evidencias y la Escuela de Medicina. Gac Med Mex 2004, 140:314-316.
• [23]Liabsuetrakul T, Suntharasaj T, Tangtrakulwanich B, Uakritdathikarn T, Pornsawat P: Longitudinal analysis of integrating evidence-based medicine into a medical student curriculum. Fam Med 2009, 41(8):585-8.
• [24]Kang M, Ragan B, Park J: Issues in outcomes research: an overview of randomization techniques for clinical trials. J Athl Train 2008, 43(2):215-221.
• [25]Fraenkel JR, Wallen NE: How to Design and Evaluate Research in Education. 5th edition. New York: McGraw-Hill; 2003.
• [26]Harris AD, McGregor JC, Perencevich EN, Furuno JP, Zhu J, Peterson DE, Finkelstein J: The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc 2006, 13:16-23.
• [27]Howe A, Keogh-Brown M, Miles S, Bachmann M: Expert consensus on contamination in educational trials elicited by a Delphi exercise. Med Educ 2007, 41(2):196-204.
• [28]Lifshitz A, Sánchez-Mendiola M: Medicina Basada en Evidencias. México: McGraw-Hill Interamericana; 2002.
• [29]Taylor R, Reeves B, Mears R, Keast J, Binns S, Ewings P, Khan K: Development and validation of a questionnaire to evaluate the effectiveness of evidence-based practice teaching. Med Educ 2001, 35:544-7.
• [30]Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C, Green M: Instruments for evaluating education in evidence-based practice. A systematic review. JAMA 2006, 296:1116-1127.
• [31]Downing SM: Twelve steps for effective test development. In Handbook of Test Development. Edited by Downing SM, Haladyna TM. Mahwah, N.J: Lawrence Erlbaum Associates; 2006:3-25.
• [32]Cohen J: Statistical power analysis for the behavioral sciences. 2n edition. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.
• [33]Cook DA: Randomized controlled trials and meta-analysis in medical education: what role do they play? Med Teach 2012, 34(6):468-73.
• [34]Khan KS, Coomarasamy A: A hierarchy of effective teaching and learning to acquire competence in evidence-based medicine. BMC Med Educ 2006, 6:59. Available in: http://www.biomedcentral.com/1472-6920/6/59 webcite BioMed Central Full Text
• [35]Feldstein DA, Maenner MJ, Srisurichan R, Roach MA, Vogelman BS: Evidence-based medicine training during residency: a randomized controlled trial of efficacy. BMC Med Educ 2010, 10:59. http://www.biomedcentral.com/1472-6920/10/59 webcite BioMed Central Full Text
• [36]Taylor RS, Reeves BC, Ewings PE, Taylor RJ: Critical appraisal skills training for health care professionals: a randomized controlled trial. BMC Med Educ 2004, 4(1):30. http://www.biomedcentral.com/1472-6920/4/30 webcite BioMed Central Full Text
• [37]Bradley P, Oterholt C, Herrin J, Nordheim L, Bjørndal A: Comparison of directed and self-directed learning in evidence-based medicine: a randomized controlled trial. Med Educ 2005, 39(10):1027-35.
• [38]Letelier LM, Zamarin N, Andrade M, Gabrielli L, Caiozzi G, Viviani P, Riquelme A: Exploring language barriers to Evidence-based Health Care (EBHC) in post-graduate medical students: a randomised trial. Educ Health (Abingdon) 2007, 20(3):82.
• [39]Tomatis C, Taramona C, Rizo-Patrón E, Hernández F, Rodríguez P, Piscoya A, Gonzales E, Gotuzzo E, Heudebert G, Centor RM, Estrada CA: Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships. J Eval Clin Pract 2011, 17(4):644-50.
• [40]Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L: Accuracy of physician self-assessment compared with observed measures of competence. A systematic review. JAMA 2006, 296:1094-1102.
• [41]Lai NM, Teng CL: Self-perceived competence correlates poorly with objectively measured competence in evidence based medicine among medical students. BMC Med Educ 2011, 11:25. http://www.biomedcentral.com/1472-6920/11/25 webcite BioMed Central Full Text
• [42]Cheng HM, Guo FR, Hsu TF, Chuang SY, Yen HT, Lee FY, Yang YY, Chen TL, Lee WS, Chuang CL, Chen CH, Ho T: Two strategies to intensify evidence-based medicine education of undergraduate students: a randomised controlled trial. Ann Acad Med Singapore 2012, 41(1):4-11.
• [43]Rubin DC, Wenzel AE: One hundred years of forgetting: a quantitative description of retention. Psychol Rev 1996, 103:734-760.
• [44]Krueger PM: Teaching critical appraisal: a pilot randomized controlled outcomes trial in undergraduate osteopathic medical education. J Am Osteopath Assoc 2006, 106(11):658-62.
• [45]Sullivan GM, Feinn R: Using effect size - or why the P value is not enough. J Grad Med Educ 2012, 4(3):279-82.
• [46]Norman G: The effectiveness and effects of effect sizes. Adv Health Sci Educ Theory Pract 2003, 8(3):183-7.
• [47]West CP, Jaeger TM, McDonald FS: Extended evaluation of a longitudinal medical school evidence-based medicine curriculum. J Gen Intern Med 2011, 26(6):611-5.
• [48]Hatala R, Keitz SA, Wilson MC, Guyatt G: Beyond journal clubs. Moving toward an integrated evidence-based medicine curriculum. J Gen Intern Med 2006, 21:538-541.