Evidence-based medicine: discrepancy between perceived competence and actual performance among graduating medical students

Abstract

Since at the time of graduation from medical school physicians are expected to demonstrate adequate professional competence including mastery of critical appraisal skills, we conducted a preliminary, cross-sectional, web-based study to examine the extent to which fourth year medical students in the US are competent in core areas of evidence-based medicine (EBM). Using self-assessment instruments, subjects (n = 150) were asked to demonstrate their ability to understand the practical meaning of key methodological and data analysis constructs as they relate to patient care, to rate their perceived competence in core areas of EBM and to disclose their attitudes toward critical appraisal of the literature and EBM. The mean score in our cohort was 55% suggesting that students may have knowledge gaps that interfere with their ability to critically appraise the medical literature. There was an apparent chasm between subjects' perceived competence and their actual performance on the assessment instrument. These findings, if corroborated in larger studies, (1) suggest that better education in EBM is needed so as to avoid the possibility that patient care may inadvertently be jeopardized; and (2) cast doubt on the use of self-assessed knowledge as a proxy for actual skills with respect to EBM and medical decision-making.

Comparison of Pharmacy Students’ Perceived and Actual Knowledge Using the Pharmacy Curricular Outcomes Assessment

“…Also, the lack of correlation or presence of only a weak correlation between perceived and externally measured knowledge seen in our study is similar to that reported in studies of students in other health science training programs. [5][6][7][8][9][10][11] The tendency of pharmacy students to overestimate their own abilities was reported in a study of 117 senior-level BS Pharm students. 6 Interestingly, in that particular study, students with the lowest measured performance consistently overestimated their clinical knowledge by the largest percentile, while those scoring the highest actually underestimated their performance.…”

“…[7][8][9] Studies comparing the accuracy of physician self-assessment and external assessments also reported weak or no association. 10,11 Interestingly, with regard to skill performance, a few studies in the health professions found that those who were the most confident in their skills performed the worst on external assessments. 12,13 Using data from perception surveys to evaluate program quality and guide curricular development can be problematic if pharmacy students' accuracy in self-assessing their knowledge, skills, and ability is flawed.…”

Cross-cultural Comparison of Pharmacy Students’ Attitudes, Knowledge, Practice, and Barriers Regarding Evidence-based Medicine

“…[35][36][37] Although there is an overwhelming emphasis on the importance of EBM, its implementation into practice is still suboptimal. [38][39][40] The ever-expanding base of medical knowledge and research evidence, along with increasing complexity of disease management of patients with multiple comorbidities in aging societies presents challenges for widespread EBM implementation. As others have found, [35][36][37] educational interventions that change behavior in learners to establish a new routine of actual EBM use are needed to be integrated into EBM curricula.…”

How can we promote and facilitate effective study skills in medical students?

“…For this reason, the ability to critically appraise information sources is a vital part of medical education (20 …”