Academic journal article American Journal of Pharmaceutical Education

An Evidence-Based Medicine Elective Course to Improve Student Performance in Advanced Pharmacy Practice Experiences

Academic journal article American Journal of Pharmaceutical Education

An Evidence-Based Medicine Elective Course to Improve Student Performance in Advanced Pharmacy Practice Experiences

Article excerpt

INTRODUCTION

Evidence-based medicine (EBM) is a health care principle of incorporating knowledge gained from the best available research evidence with clinical expertise, and applying this to individual patient circumstances. (1) Practicing EBM requires a clinician to perform critical skills that are not used frequently in daily practice, including performing efficient literature searches and applying the formal rules of evidence and biostatistics in evaluating the medical literature. (1,2) A 2007 survey of British Medical Journal readers elected the concept of EBM as 1 of the top 15 medical milestones of the past 150 years. (2,3) Although this concept inherently may represent one of common sense, its role in changing focused patient care is undeniable. With the shift to an interdisciplinary team approach, pharmacists play a critical role in the evidence-based decision-making process, serving as a source of scientifically valid information, and experts on best practices in the appropriate use of medications.

The American College of Clinical Pharmacy (ACCP) emphasizes that clinical pharmacists serve as a source of objective, evidence-based therapeutic information and recommendations. (4) A pharmacist can proactively ensure rational drug therapy and avert many medication misadventures due to therapeutic decisions made at the point of prescribing. (4) Arming student pharmacists with the ability to read and critically appraise the literature to maintain an up-to-date knowledge base is essential. The ever-expanding body of literature adds yet another layer of complexity to efficient and accurate literature identification and evaluation. As an example, the National Library of Medicine's MEDLINE database indexes over 5,000 journals and nearly 20 million citations. (5) Each day an average of 1,950 citations are uploaded to the database, stressing the need for students to develop strong literature search skills to appropriately and efficiently maintain a working knowledge of the medical literature.

Courses enhancing EBM skills are offered throughout health sciences education and training, but only a few studies have evaluated these courses. (6-8) There is a significant need for EBM skills to be evaluated in every medical school curriculum. (6) Medical students briefly trained in conducting EBM-searches were able to obtain more relevant and complete search results compared to students who did not receive training. (7) Likewise, active-learning strategies in a drug information and literature evaluation course resulted in improvement in pharmacy students' ability and confidence to perform the course's objectives. The skill set used in acquiring, interpreting, and applying evidence-based medicine practices is formally taught in a required course in only 42% of surveyed US colleges and schools of pharmacy, even though the representative surveyed felt these principles should be incorporated into the curriculum to a greater degree. (9)

The Center for Advancement of Pharmaceutical Education (CAPE) outcomes suggest that providing patient-centered pharmaceutical care in an interprofessional health care team should be based on sound therapeutic principles and evidence-based data. The pharmacist is called to retrieve, analyze, and interpret the lay, professional, and scientific literature to provide drug information to patients, their families, and other involved health care providers. (10) Further, in concordance with the standards outlined in the Accreditation Council for Pharmacy Education (ACPE), PharmD graduates must be educated to deliver patient-centered care as members of an interprofessional team, emphasizing evidence-based principles. (11)

Fourth-year pharmacy students completing their advanced pharmacy practice experiences (APPEs) are given numerous opportunities to practice evidence-based medicine when conducting journal club discussions, making drug information queries, discussing clinical pearls on medical rounds, and making patient care decisions. …

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