Impact of an Evidence-Based Medicine Curriculum on Medical Students' Attitudes and Skills

Article excerpt

Purpose: This evaluation study sought to assess the impact of an evidence-based medicine (EBM) course on students' self-perception of EBM skills, determine their use of EBM skills, and measure their performance in applying EBM skills in a simulated case scenario.

Methods: Pre- and post-surveys and skills tests were developed to measure students' attitudes toward and proficiency in EBM skills. Third-year students completed the voluntary survey and skills test at the beginning and completion of a twelve-week clerkship in internal medicine (IM) co-taught by medical and library faculty. Data were analyzed using the Mann-Whitney U test for a two-tailed test.

Results: A statistically significant increase was found in the students' self-assessment of skills. Students reported using the journal literature significantly more frequently during the clerkship than before, although textbooks remained their number one resource. A majority of students reported frequent use of EBM skills during the clerkship. Statistically significant improvement in student performance was also found on the posttest, although the level of improvement was more modest than that found on the post-surveys.

Conclusion: The introduction of EBM skills to students during a clinical clerkship provides students an opportunity to practice EBM skills and reinforces the use of evidence in making patient-care decisions.

INTRODUCTION

The Medical School Objectives Project of the Association of American Medical Colleges (AAMC) identified attributes, knowledge, and skill sets that medical students should possess at the time of graduation. One of the identified skills was the ability to retrieve, manage, and utilize biomedical information for clinical decision making. Further, the report advocated incorporating evidence-based medicine (EBM) principles throughout undergraduate medical education [1]. In response to this recommendation, teaching of EBM with its associated skills of literature searching and critical appraisal, took hold in the last decade and has become even more widespread in medical education at the graduate and undergraduate levels [2-5].

A critical appraisal course, focusing on finding and evaluating the best evidence, was formally introduced into the undergraduate curriculum at the University of Illinois College of Medicine at Peoria (UICOMP) in the mid-1980s, and, from the beginning, library involvement was integral to the program [6]. A controlled study in 1992 found that Peoria students scored significantly higher on a test of critical appraisal skills compared with students at another regional site of the medical college who had not received such instruction [7]. In the intervening years, the course continued to develop and evolve in response to student and faculty feedback, course evaluations, and knowledge gained about the teaching of EBM [8].

A recent restructuring of the EBM curriculum emphasized an interactive and real-time approach to learning. To test the effectiveness of this approach, faculty developed a two-part evaluation plan that included a pre- and post-clerkship survey to assess students' self-perceived EBM skills and attitudes and a pre- and posttest to measure their application of EBM skills to a clinical case scenario. The objectives of the evaluation were to (1) assess the self-perception of students' EBM skills before and after completion of the EBM seminar series, (2) determine whether students used EBM skills for patient-care decisions during the clerkship, and (3) measure student performance on a standardized case scenario that required application of EBM skills.

LITERATURE REVIEW

Much of what is known about the effectiveness of curricula for evidence-based practice relies on observational data as reported in the literature [9]. A 1998 systematic review of the effectiveness of instruction in critical appraisal identified seventeen studies, only ten of which were found to be methodologically acceptable, according to the author's inclusion criteria of having a control group and a direct measure of performance. …