ContextEvidence-based practice (EBP) is the integration of the best research evidence with patients' values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness.ObjectiveTo appraise, summarize, and describe currently available EBP teaching evaluation instruments.Data Sources and Study SelectionWe searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument.Data ExtractionTwo raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes.Data SynthesisOf 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures.ConclusionsInstruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

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Instruments for Evaluating Education in Evidence-Based Practice: A Systematic Review

Background Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. This is an update of a Cochrane review first published in 2001. Objectives To assess the effects of teaching critical appraisal skills to health professionals on the process of care, patient outcomes and knowledge of health professionals. SEARCH METHODS. We updated the search (see Appendix 1 for search strategies by database) and used those search strategies to search the Cochrane Central Register of Controlled Trials (1997 to June 2011) and MEDLINE (from 1997 to June 2011). We also searched EMBASE, CINAHL and PsycINFO (up to January 2010). We searched LISA (up to January 2010), ERIC (up to January 2010), SIGLE (up to January 2010) and Web of Knowledge (up to January 2010). We also searched the Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register up to January 2010. Selection criteria Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses that examined the effectiveness of educational interventions teaching critical appraisal to health professionals. The outcomes included process of care, patient mortality, morbidity, quality of life and satisfaction. We included studies reporting on health professional knowledge/awareness only when based upon objective, standardised, validated instruments. We did not consider studies involving students. Data collection and analysis Two review authors independently extracted data and assessed risk of bias. We contacted authors of included studies to obtain missing data. Main results In total, we reviewed a total of 11,057 titles and abstracts, of which 148 appeared potentially relevant to the review. We included three studies involving 272 people in this review. None of the included studies evaluated process of care or patient outcomes. Statistically significant improvements in participants' knowledge were reported in domains of critical appraisal (variable approaches across studies) in two of the three studies. We determined risk of bias to be 'unclear' and as such considered this to be 'plausible bias that raises some doubt about the results'. Authors' conclusions Low-intensity critical appraisal teaching interventions in healthcare populations may result in modest gains. Improvements to research examining the effectiveness of interventions in healthcare populations are required; specifically rigorous randomised trials employing interventions using appropriate adult learning theories.

Teaching critical appraisal skills in healthcare settings

Background: Despite the widespread teaching of evidence-based medicine (EBM) to medical students, the relevant literature has not been synthesized appropriately as to its value and effectiveness.Aim: To systematically review the literature regarding the impact of teaching EBM to medical students on their EBM knowledge, attitudes, skills and behaviors.Methods: MEDLINE, SCOPUS, Web of science, ERIC, CINAHL and Current Controlled Trials up to May 2011 were searched; backward and forward reference checking of included and relevant studies was also carried out. Two investigators independently extracted data and assessed the quality of the studies.Results: 10,111 potential studies were initially found, of which 27 were included in the review. Six studies examined the effect of clinically integrated methods, of which five had a low quality and the other one used no validated assessment tool. Twelve studies evaluated the effects of seminars, workshops and short courses, of which 11 had a low quality and t...

/pdf/effectiveness-of-teaching-evidence-based-medicine-to-28uvl88wr2.pdf

Effectiveness of teaching evidence-based medicine to undergraduate medical students: a BEME systematic review.

Rationale, aims and objectives  Traditional continuing medical education programmes that offer passive learning have been shown to be poorly effective at changing doctors’ clinical behaviour. A multifaceted evidence-based medicine (EBM) intervention was conducted at the largest health maintenance organization (HMO) in Israel, attempting to facilitate a change in doctors’ attitudes, knowledge and clinical behaviour. No study thus far has examined the association between the teaching of EBM principles and doctors’ clinical behaviour. This study evaluated the intervention programme through a controlled trial and before and after study. The objective of the evaluation is binary: first, to examine the impact of an educational intervention on family doctors’ test ordering performance and drug utilization by their patients; and second, to assess the impact of the intervention on attitudes towards evidence-based practice and knowledge.



Methods  Controlled trial and before and after study. Primary care clinics comprising similar patient characteristics were randomly allocated to the experimental or to the control group. Doctors in the experimental group participated in an EBM educational intervention, while the control group did not take part in the intervention. Clinicians’ test ordering performance and their patients’ drug utilization were derived from the HMO’s database before intervention, after workshops and after intervention. Participants in the controlled trial consisted of 75 doctors and their 106 349 patients. The before and after study evaluated intervention doctors’ (n = 70) EBM attitudes and knowledge through a validated questionnaire before and after workshops.



Results  EBM workshops enhanced intervention doctors’ EBM knowledge scores from 22.4/100 before workshops to 40.8/100 after workshops (P = 0.000). Doctors improved their ability to formulate clinical questions while enhancing their search strategy using Medline. In a linear regression model, two covariates, specialization (B = 12.59; P = 0.001) and habitually reading medical journals (B = 6.45; P = 0.052), best explained the variance in doctors’ EBM knowledge scores, while controlling for pre-intervention scores (R2 = 0.569; P = 0.000). Results from the controlled trial indicated that no statistically significant differences were found between intervention and control doctors’ test ordering performances, and their patients’ drug utilization.



Conclusions  The results of the study suggest that the intervention positively influenced attitudes and knowledge; however, no statistically significant impact was found on doctors’ test ordering performance and on their patients’ drug utilization. The intervention’s inability to change doctors’ clinical behaviour might be remedied by improving future interventions through adding additional facets to the educational intervention, such as social marketing techniques and personal feedback. A longer and more extensive intervention might be more effective but is extremely difficult to execute as we found in this study. Future larger-scale interventions must incorporate the intervention into the routines of the organization, thus minimizing barriers towards EBM implementation.

Evaluating the impact of an evidence-based medicine educational intervention on primary care doctors' attitudes, knowledge and clinical behaviour: a controlled trial and before and after study.

Objective: To evaluate the effect of a three-hour training session in formulating questions and searching databases.Design: A randomised controlled trial and before and after study, with blinded outcome assessment.Setting: Oxford University Medical School, first clinical year.Subjects: Altogether 108 medical students were randomly assigned to an experimental group (54) or a control group (54), and all were given the task of searching for evidence around an ulcer related problem or a cardiac problem. Students in the experimental group were randomly allocated to research one of the two problems before training and the remaining problem afterwards. Control students received no training and were randomly allocated to search for evidence around either of these problems.Main outcome measures: Searching performance; the quality of evidence retrieved; student satisfaction.Results: Training improved the students' search performance and the quality of evidence retrieved. Students' satisfaction with the training was high.Conclusions: A three-hour interactive training session improved the students' ability to search databases and retrieve evidence and was well received by the students.

Improving searching skills and evidence retrieval.

A study of the effectiveness of a collaborative course in teaching library and critical appraisal skills was conducted at the University of Illinois College of Medicine. A critical appraisal and library skills course was taught at the Peoria site during the third-year medical clerkship. The performance of Peoria students on a twenty-item multiple choice posttest was compared to that of third-year students in Rockford, who received no library or critical appraisal instruction during their medicine clerkship. The two groups were similar in self-perceived library skills, critical appraisal skills, and other demographic values. Peoria students scored significantly higher on library, critical appraisal, and total posttest questions. An improving trend during the year was not observed at either site, implying that students were not acquiring these skills in day-to-day clerkship activities. Results suggest that this multidisciplinary course is effective in teaching library and critical appraisal skills.

A multidisciplinary approach to information management and critical appraisal instruction: a controlled study.

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A multidisciplinary approach to information management and critical appraisal instruction: a controlled study.