Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine

Green, Michael L.

doi:10.1097/00001888-199906000-00017

Cited by 161 publications

(122 citation statements)

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“…15,16 While teaching the end-user to read critically made sense, these curricular additions predated the dynamic and networking powers of the Internet. Traditional methods of critical appraisal (i.e., individual users personally appraising every piece of literature) may not be sufficient or even practical in the digital age due to the sheer volume of material produced.…”

Section: The Future Of Evidence-based Medicinementioning

confidence: 99%

Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction

Chan

Trueger

Roland

et al. 2017

CJEM

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The integration of new knowledge into clinical practice continues to lag behind discovery. The use of Free Open Access Medical education (FOAM) has disrupted communication between emergency physicians, making it easy for practicing clinicians to interact with colleagues from around the world to discuss the latest and highest impact research. FOAM has the potential to decrease the knowledge translation gap, but the concerns raised about its growing influence are 1) research that is translated too quickly may cause harm if its findings are incorrect; 2) there is little editorial oversight of online material; and 3) eminent online individuals may develop an outsized influence on clinical practice. We propose that new types of scholars are emerging to moderate the changing landscape of knowledge translation: 1) critical clinicians who critically appraise research in the same way that lay reviewers critique restaurants; 2) translational teachers adept with these new technologies who will work with researchers to disseminate their findings effectively; and 3) interactive investigators who engage with clinicians to ensure that their findings resonate and are applied at the bedside. The development of these scholars could build on the promise of evidence-based medicine by enhancing the appraisal and translation of research in practice. RÉSUMÉEncore aujourd'hui, il s'écoule un certain temps entre les découvertes et l'intégration des nouvelles connaissances dans la pratique clinique. L'arrivée du mouvement Free Open Access Meducation (FOAM) a bouleversé les communications entre les médecins d'urgence, en permettant aux praticiens d'interagir facilement avec des homologues de partout dans le monde pour discuter des derniers travaux de recherche et de ceux qui ont la plus forte incidence. Le mouvement FOAM peut certes combler des lacunes en matière d'application des connaissances, mais son utilisation soulève des préoccupations quant à son influence grandissante : 1) l'application trop rapide des résultats de la recherche peut s'avérer préjudiciable si les constatations sont erronées; 2) la documentation en ligne échappe en grande partie à la supervision rédactionnelle; 3) des personnes de renom en ligne peuvent finir par exercer une influence trop grande en pratique clinique. Aussi les auteurs de l'article proposent-ils que de nouveaux types d'érudits voient le jour afin de régler le monde en mutation de l'application des connaissances. Ainsi, les cliniciens critiques feraient l'évaluation critique de la recherche à la manière des critiques profanes de restaurants; les formateurs en application des connaissances, versés dans le domaine des nouvelles techniques, travailleraient en collaboration avec les chercheurs à la diffusion efficace des résultats de leurs travaux; et les chercheurs interactifs s'engageraient dans des échanges avec les cliniciens afin de s'assurer que leurs résultats trouvent bel et bien écho dans la pratique clinique. La formation de ces groupes d'érudits pourrait prendre appui sur les grands p...

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Section: The Future Of Evidence-based Medicinementioning

confidence: 99%

Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction

Chan

Trueger

Roland

et al. 2017

CJEM

View full text Add to dashboard Cite

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“…4 Historically, the majority of EBM courses have been seminar series, workshops, or "short courses". [5][6][7][8] Courses of EBM instruction integrated longitudinally with clinical practice are rare, [9][10][11] despite limited but supportive evidence in favor of such teaching approaches to EBM. 12 Objective assessment of EBM skills is essential, as selfreported skills correlate poorly with actual EBM knowledge.…”

Section: Introductionmentioning

confidence: 99%

Extended Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum

2011

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BACKGROUND: Evidence-based medicine (EBM) is an important element of medical education. However, limited information is available on effective curricula. OBJECTIVE: To evaluate a longitudinal medical school EBM curriculum using validated instruments. DESIGN, PARTICIPANTS, MEASUREMENTS: We evaluated EBM attitudes and knowledge of medical students as they progressed through an EBM curriculum. The first component of the curriculum was an EBM "short course" with didactic and small-group sessions occurring at the end of the second year. The second component integrated EBM assignments with third-year clinical rotations. The 15-point Berlin Questionnaire was administered before the course in 2006 and 2007, after the short course, and at the end of the third year. The 212-point Fresno Test was administered before the course in 2007 and 2008, after the short course, and at the end of the third year. Selfreported knowledge and attitudes were also assessed in all three classes of medical students. RESULTS: EBM knowledge scores on the 15-point Berlin Questionnaire increased from baseline by 3.0 points (20.0%) at the end of the second year portion of the course (p<001) and by 3.4 points (22.7%) at the end of the third year (p<001). EBM knowledge scores on the 212-point Fresno Test increased from baseline by 39.7 points (18.7%) at the end of the second year portion of the course (p<001) and by 54.6 points (25.8%) at the end of the third year (p<001). On a 5-point scale, self-rated EBM knowledge increased from baseline by 1.0 and 1.4 points, respectively (both p<001). EBM was felt to be of high importance for medical education and clinical practice at all time points, with increases noted after both components of the curriculum. CONCLUSIONS: A longitudinal medical school EBM was associated with markedly increased EBM knowledge on two validated instruments. Both components of the curriculum were associated with gains in knowledge. The curriculum was also associated with increased perceptions of the importance of EBM for medical education and clinical practice.KEY WORDS: medical education; evidence-based medicine; medical school.

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“…12 Despite the overlap and relevance of shared decision making to two areas (evidence-based practice and patient communication), teaching of these skills seems to fall between the two, with neither routinely covering the topic. Much of the skill focus of evidence-based practice teaching is on finding and appraising evidence, [13][14][15] and shared decision making is not commonly covered under the umbrella of communication skills. This is demonstrated by its omission as an essential skill in a UK national consensus statement of communication curricula for medical programs 16 and its omission from the accreditation standards for USA medical schools.…”

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confidence: 99%

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

et al. 2014

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BACKGROUND: Shared decision making is a crucial component of evidence-based practice, but a lack of training in the "how to" of it is a major barrier to its uptake. OBJECTIVE: To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians. DESIGN: Multi-centre randomized controlled trial. PARTICIPANTS: One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities. INTERVENTION:The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills. MAIN MEASURES: The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays. Secondary outcomes: confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS)). KEY RESULTS: Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference=18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference=0.9, 95 % CI 0.5 to 1.3), confidence measure (difference=13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference=0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale. CONCLUSIONS: This brief intervention was effective in improving student clinicians' ability, attitude towards, and confidence in shared decision making facilitation.Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training. INTRODUCTIONWhile various definitions abound, the core tenets of shared decision making include: a two-way exchange of information between the patient and clinician, discussion and deliberation of the possible options and their outcomes, and the clinician and patient both participating in the decision making process and arriving at a decision. 1 Successful evidence-based practice requires clinicians to incorporate patient values and preferences and utilise shared decision making. 2 Indeed, shared decision making can be viewed as a prerequisite to evidencebased practice. 3 However, shared decision making has not been routinely adopted by health professionals. There are barriers to its implementation. 4 One barrier is simply the lack of teaching clinicians the "how to". Recent commentaries about shared de...

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Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine

Cited by 161 publications

References 0 publications

Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction

Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction

Extended Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

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