Teaching Evidence-Based Medicine Literature Searching Skills to Medical Students during the Clinical Years: A Randomized Controlled Trial

Article excerpt

Objectives: Constructing an answerable question and effectively searching the medical literature are key steps in practicing evidence-based medicine (EBM). This study aimed to identify the effectiveness of delivering a single workshop in EBM literature searching skills to medical students entering their first clinical years of study.

Methods: A randomized controlled trial was conducted with third-year undergraduate medical students. Participants were randomized to participate in a formal workshop in EBM literature searching skills, with EBM literature searching skills and perceived competency in EBM measured at one-week post-intervention via the Fresno tool and Clinical Effectiveness and Evidence-Based Practice Questionnaire.

Results: A total of 121 participants were enrolled in the study, with 97 followed-up post-intervention. There was no statistical mean difference in EBM literature searching skills between the 2 groups (mean difference50.007 (P50.99)). Students attending the EBM workshop were significantly more confident in their ability to construct clinical questions and had greater perceived awareness of information resources.

Conclusions: A single EBM workshop did not result in statistically significant changes in literature searching skills. Teaching and reinforcing EBM literature searching skills during both preclinical and clinical years may result in increased student confidence, which may facilitate student use of EBM skills as future clinicians.

INTRODUCTION

Competency in evidence-based medicine (EBM) provides clinicians with the ability to identify, evaluate, and integrate evidence into clinical decision making. Two of the five critical steps in achieving competency in EBM are to (1) construct an answerable question from the clinical environment and (2) effectively and efficiently search the medical literature to identify the best available evidence to answer the question [1]. EBM users must be proficient in these skills before evidence can be appraised (step 3), integrated into clinical practice (step 4), and evaluated (step 5).

Various training modules and courses in EBM are now commonly implemented in medical schools worldwide [2]. The aim of such EBM programs is to provide an integration of knowledge, cognitive skills, and behaviour that promotes lifelong learning for future medical graduates [3]. There is a small, but growing evidence base evaluating how to best educate medical students and clinicians in the principles of EBM [3, 4]. The limitation of the current evidence base is that majority of these studies have focused on evaluating critical appraisal skills, with few focused on training medical undergraduates in the critical steps of constructing an answerable question and effectively searching the literature. Those studies that have been published report an improvement in the EBM skills of undergraduate medical students using a variety of interventions [5-7].

A before and after study of sixty third-year medical students in 2000 reported improvement in EBM skills following a mini-course in EBM, consisting of four sessions about writing clinical questions, searching MEDLINE, appraising articles critically, and applying evidence [5]. A 2005 non-randomized controlled trial reported the positive impact of a single MEDLINE workshop delivered to fourth-year medical students [6]. Students were provided with a clinical scenario and asked to develop a search strategy, which was assessed by a librarian using a search strategy analysis instrument. Students who attended the workshop produced higher quality search strategies, compared to those who did not attend the workshop. Similarly, a 1998 randomized controlled trial (RCT) allocating firstyear medical students to a single training session on formulating questions and searching also identified improvement in question design and search skills for students receiving the intervention [7].

Although these various studies have identified the positive impact of EBM workshops on students, none have identified when specific EBM skills, such as effectively searching the medical literature, should be taught-be it during a medical student's preclinical or clinical years of study. …