A Collaborative Teaching Strategy for Enhancing Learning of Evidence-Based Clinical Decision-Making

Article excerpt

The educational literature cites a lack of student motivation to learn how to use research evidence in clinical decision- making because the students do not observe clinicians using evidence. This lack of motivation presents a challenge to educators as they seek to instill the value of evidence- based clinical decision-making (EBCD) in students. One problem is that students in entry-level programs do not have the experience needed to know what to look for, and secondly, clinical decision-making is contextually based in a patient problem. Our approach offers one solution to bridging the gap between classroom teaching and real-world implementation of EBCD through a three-phase collaborative approach. Occupational and physical therapy students are partnered with clinicians to find and appraise evidence to answer the real-world questions posed by these therapists. This paper describes the implementation of the partnership, teaching/learning outcomes, logistics, and implications for clinicians. We found this approach increased student motivation and greatly enhanced the learning experience. Future directions include implementing a framework which allows for the assessment of the strategy on the facility and creates opportunities to integrate the use of EBCD in all aspects of facility practice. J Allied Health 2011; 40(3):120-127.

THE PRACTICE OF EVIDENCE-BASED MEDICINE is well documented as the conscientious, explicit, and judicious use of current best evidence in making clinical decisions about the care of specific patients.1 In rehabilitation therapies, the use of evidence-based clinical decisionmaking (EBCD) has been discussed since the mid-1990s. Holm, in 2000, challenged therapists to be able to respond when their patients asked "how do you know that what you do really works?" and to be able to provide them "with the research evidence, similar to what comes in prescription pamphlets."2[p575]

This question and others like it have moved rehabilitation therapies to embrace EBCD in academic training programs. However, although research studying the implementation of clinical decision-making processes in rehabilitation settings reveals positive attitudes toward the concept, it also suggests that EBCD is having little impact on how therapists create their plan of care.1-4 To illustrate, a study examining evidence-based practice in social work reported that students had no examples in practice observations of the use of evidence in clinical decision-making.4 This failure of practicing clinicians to utilize evidence in clinical decision-making is observed by students during preprofessional fieldwork experiences. Consequently, from the student's perspective, information presented in the classroom about research methods, levels of evidence, and the analysis of research may be viewed as removed from the clinical setting, diminishing its value to practice.

This article describes a collaboration between an academic training program and a rehabilitation hospital designed to partner practicing clinicians and therapy students with the aim of increasing the relevance of skills necessary to support EBCD and, accordingly, the motivation to use them.

Background and Purpose

In the past two decades, there have been numerous articles in the health professions literature about how to teach students to utilize evidence in clinical decision-making.5-13 This literature discusses several approaches, including single course designs, consecutive course sequences, and the threading of evidence throughout the curriculum.14-16 Specific classroom strategies have focused primarily on traditional teaching methods connecting research to practice through active learning strategies.8 For example, Shlonsky and Stern9 described how utilization of evidence in social work practice decisions depends on having the clinical skill or experience to understand the client's preferences. Their approach to teach these skills was to integrate EBCD throughout the curriculum and replaced courses in the curriculum covering research methods with a course on evidence appraisal. …