Teaching evidence-based medicine: Difference between revisions
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A controlled trial of teaching Bayesian principles (probabilistic reasoning) "improves the efficiency of test ordering."<ref name="pmid2492066">{{cite journal |author=Davidoff F ''et al.'' |title=Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education |journal=Medical care |volume=27 |pages=45–58 |year=1989 |pmid=2492066 |doi=}}</ref> | A controlled trial of teaching Bayesian principles (probabilistic reasoning) "improves the efficiency of test ordering."<ref name="pmid2492066">{{cite journal |author=Davidoff F ''et al.'' |title=Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education |journal=Medical care |volume=27 |pages=45–58 |year=1989 |pmid=2492066 |doi=}}</ref> | ||
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Revision as of 06:28, 19 November 2007
Studies of the effectiveness of teaching evidence-based medicine
A systematic review of the effectiveness of teaching EBM concluded "standalone teaching improved knowledge but not skills, attitudes or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes and behaviour."[1] A second review concluded improvements in unvalidated measures of "knowledge, skills, attitudes or behavior."[2] Neither review examined improvements in clinical care.
Two systematic reviews of EBM provide the framework below for measuring outcomes.[3][4]
Information retrieval
Increasing use of information
A randomized controlled trial of volunteer senior medical students found that access to information portal on a handheld computer increased self-reported use of information.[5] The information portal contained multiple pre-appraised resources, including a textbook and drug resource, and would best resemble the "user" mode. The study was not able to isolate which resources in the portal had increased use. It is possible that the benefit was solely due to the textbook or drug resource.
A randomized controlled trial of teaching and encouraging use of MEDLINE by medical resident physicians showed increased searching for evidence during 6-8 weeks of observation.[6] Based on the median number of searches and hours spent searching, each search averaged 22 minutes, which may not be sustainable over the long term.
Improving clinical care
Teaching "user" mode only using syntheses and synopses, without summaries, has not shown benefit in two studies. A controlled trial of teaching the "user" mode (see above) was negative.[7] However, this study encouraged the use of syntheses and synopses and did not encourage the more practical "summaries" (evidence-based textbooks) of the "5S" search strategy.[8] A quasi-randomized, controlled investigation of teaching medical students the use of studies, syntheses, and synopses using an automated search engine was negative.[9]
Information awareness
A cluster randomized trial of McMaster Premium LiteratUre Service (PLUS) led to " increased the utilization of evidence-based information from a digital library by practicing physicians."[10]
No controlled studies have addressed improving clinical care by use of information awareness strategies.
A controlled trial of teaching Bayesian principles (probabilistic reasoning) "improves the efficiency of test ordering."[11]
References
- ↑ Coomarasamy A, Khan KS (2004). "What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review". BMJ 329: 1017. DOI:10.1136/bmj.329.7473.1017. PMID 15514348. Research Blogging.
- ↑ Flores-Mateo G, Argimon JM (2007). "Evidence based practice in postgraduate healthcare education: a systematic review". BMC Health Services Research 7: 119. DOI:10.1186/1472-6963-7-119. PMID 17655743. Research Blogging.
- ↑ Shaneyfelt T et al (2006). "Instruments for evaluating education in evidence-based practice: a systematic review". JAMA 296: 1116–27. DOI:10.1001/jama.296.9.1116. PMID 16954491. Research Blogging.
- ↑ Straus SE et al (2004). "Evaluating the teaching of evidence based medicine: conceptual framework". BMJ 329: 1029–32. DOI:10.1136/bmj.329.7473.1029. PMID 15514352. Research Blogging.
- ↑ Leung GM et al. (2003). "Randomised controlled trial of clinical decision support tools to improve learning of evidence based medicine in medical students". BMJ 327: 1090. DOI:10.1136/bmj.327.7423.1090. PMID 14604933. Research Blogging.
- ↑ Cabell CH et al. (2001). "Resident utilization of information technology". J Gen Intern Med 16: 838–44. PMID 11903763. [e]
- ↑ Shuval K et al. (2007). "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". Journal of Evaluation in Clinical Practice 13: 581–98. DOI:10.1111/j.1365-2753.2007.00859.x. PMID 17683300. Research Blogging.
- ↑ Haynes RB (2006). "Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions". ACP J Club 145: A8. PMID 17080967. [e]
- ↑ Badgett RG et al. (2001). "Teaching clinical informatics to third-year medical students: negative results from two controlled trials". BMC Medical Education 1: 3. PMID 11532204. [e] PubMed Central
- ↑ Haynes RB et al. (2006). "McMaster PLUS: a cluster randomized clinical trial of an intervention to accelerate clinical use of evidence-based information from digital libraries". Journal of the American Medical Informatics Association : JAMIA 13: 593–600. DOI:10.1197/jamia.M2158. PMID 16929034. Research Blogging.
- ↑ Davidoff F et al. (1989). "Changing test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education". Medical care 27: 45–58. PMID 2492066. [e]