The impact of clinical maturity on competency in evidence-based medicine: a mixed-methods study

Ilić, Dragan; Diug, Basia

doi:10.1136/postgradmedj-2015-133487

Cited by 9 publications

(18 citation statements)

References 36 publications

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“…Also, previous research experience appears to be associated with EBM skill mastery, as shown in the 19-point (98–79) higher average score between those who have and have not participated in research. Previous investigation of EBM found a 52-point average difference between novices and experts, 7 which suggests that these average differences, while not at the same magnitude, are meaningful. For example, the difference between a resident who has and has not had previous research experience is over a third of the difference between an EBM novice and expert.…”

Section: Resultsmentioning

confidence: 95%

“… 6 Additionally, previous studies showed limited success in helping residents develop these EBM skills and knowledge, especially in contrast to medical students. 7 , 8 Finally, most studies do not consider residents’ previous experience when assessing their changes in EBM capacities, and thus, we have limited understanding on which experiences matter more in terms of long-term EBM development. Thus, we aim to provide insight into what experiences are associated with residents’ development of EBM attitudes, habits, and skills.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with practicing evidence-based medicine: a study of family medicine residents

Paulsen

Achkar

2018

AMEP

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BackgroundEvidence-based medicine (EBM) plays a critical part in ensuring that practitioners use the soundest available medical procedures while avoiding ineffective ones. As such, it plays a key role in medical residency education. However, little research has shown what factors influence residents’ adoption of habits in, self-efficacy in, and skills of EBM.Materials and methodsThis study gathered responses from a cross section of family medicine residents and new interns from 40 different residencies across the USA. The survey was based on Taylor et al’s survey of EBM attitudes and behaviors and the Fresno test’s assessment of EBM knowledge and skills. The study used negative binomial regression, ordinary least squares regression, and nonparametric tests of difference to assess the impact of residents’ background (year in residency, type of residency, previous EBM training, and previous research experience) on these EBM outcomes.ResultsResidents with previous research experience are associated with stronger EBM habits, more self-efficacy in applying EBM, and greater ability in using EBM skills. Previous research experience had a bigger impact on these outcomes than any other predictor. EBM habits, self-efficacy, and skills did not appear to show even increases by year in residency. Previous EBM training was associated with more hours spent reading the literature and higher EBM skill test scores.ConclusionOur findings suggest the practice of EBM may benefit from medical education increasing research experiences and EBM training. Research experiences provide the practical training, while EBM training provides focused instruction necessary for EBM self-efficacy, habits, and skills. These EBM outcomes are not inherently gained through time in family medicine residency. Future research, particularly longitudinal designs, should continue to pursue this line of inquiry.

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Section: Resultsmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Factors associated with practicing evidence-based medicine: a study of family medicine residents

Paulsen

Achkar

2018

AMEP

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“…pathophysiology and pharmacology courses) and also attend a mandatory course in evidence-based medicine (addressing concepts such as number needed to treat, risk reduction, odds ratio, meta-analysis), which may have contributed to the high numeracy levels observed at their entrance to the fourth study year. Previous research also indicated that clinical maturity is an important factor which may contribute to the improvement of critical reflection and numerical understanding in health context, which may also be a reason why students at clinical years had higher scores [22]. Moreover, at the clinical part of the medical curriculum, it is to be expected that students perform calculations in a clinical context daily, and thus keep their high numeracy levels.…”

Section: Discussionmentioning

confidence: 99%

Health numeracy skills of medical students:cross-sectional and controlled before-and-after study

et al. 2019

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BackgroundAlthough numeracy, defined as understanding and handling numbers, is an important skill for the medical profession, it is not clear whether it changes during graduate medical education and whether it can be improved by specific interventions. The objective of this study was to assess objective and subjective numeracy levels at different stages of medical education and explore whether a research methodology/statistics course improves numeracy levels in a longer period.MethodsWe performed cross-sectional and controlled before-and-after studies. First-year sociology students and first- to sixth-year medical students from the in the cross sectional study and two groups of first-year medical students in a controlled before-and-after study. The intervention was a course on biostatistics and research methodology using blended approach. Numeracy was measured using Subjective Numeracy Scale (Cronbach α = 0.70) and Numeracy Understanding in Medicine instrument (Cronbach α = 0.75).ResultsWhereas first-year medical students did not differ from first-year sociology students in objective numeracy, medicine students had higher results on subjective numeracy. Students from higher years of medical school had generally higher subjective and objective numeracy scores. In the controlled before-and-after study, the intervention group improved more in subjective numeracy (median difference on a 0–8 scale = 0.5, 95% CI 0.3 to 0.7 vs − 0.4, 95% CI − 0.4 to − 0.1, P < 0.001) but not in objective numeracy.ConclusionsAlthough the numeracy levels at the beginning of the medical school are within the range of non-medical population, both objective and subjective numeracy improve during the higher years of medical school. Curriculum during medical school may help in numeracy increase, while research methodology training may help to increase subjective but not objective numeracy skills.

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“…A focus group was conducted six months into the academic year, to allow enough time for the interns to become familiar with all of the EBM curricular components. The focus group goal was to better explore residents’ subjective evaluation regarding the EBM curriculum and to explore their views on how the curriculum improved their ability to more confidently apply EBM skills 16–18. Preparation and execution of the focus group was based on the checklist published by Tong et al18…”

Section: Methodsmentioning

confidence: 99%

<p>A prospective mixed-methods study evaluating the integration of an evidence based medicine curriculum into an internal medicine residency program</p>

Aneese¹,

Nasr²,

Halalau³

2019

AMEP

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Introduction Evidence based medicine (EBM) skills are often lacking in the general internal medicine physician population. Our aim is to evaluate the impact of our internal medicine EBM curriculum on the residents’ EBM skills and knowledge through mixed methods. Methods A prospective study was performed that evaluated the EBM curriculum: quantitatively, with pre/posttests and qualitatively through a focus group that addressed residents’ opinion on the educational and clinical impact of each aspect of the curriculum. Results A total of 60 internal medicine residents were surveyed. Short-term EBM skills: therapy workshops (N=25) median pretest score of 8 (IQR): [6–9]) vs posttest 8 (IQR: [8–9]), ( p =0.006); diagnosis (N=16) pretest score of 6 (IQR: [3–6]) vs posttest 7 (IQR: [6–9]), ( p =0.006); systematic review (N=13) pretest score of 4 (IQR: [4–6]) vs posttest 7 (IQR: [6–8]), ( p =0.002); and harm (N=16) pretest score of 6 (IQR: [5–7]) vs posttest 7 (IQR: [7–8]), ( p =0.004). Long-term EBM skills: Fresno test of competence in EBM, pretest median score of 110.5/212 (IQR: 96.0–124.0) and a median posttest score of 115/212 (IQR: 100.0–130.0) ( p =0.60). Having previous EBM training, being actively involved in research and being the first author on a publication was associated with higher Fresno test scores. Focus group provided qualitative feedback on the residents’ EBM curriculum perception. Conclusion This curriculum adds a significant contribution to the current field of medical education as it fills an important educational gap, through defining ways of effectively delivering EBM concepts which led to improvement in residents’ ability to evaluate and apply medical literature. The EBM curriculum was overall well received by the residents.

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The impact of clinical maturity on competency in evidence-based medicine: a mixed-methods study

Cited by 9 publications

References 36 publications

Factors associated with practicing evidence-based medicine: a study of family medicine residents

Factors associated with practicing evidence-based medicine: a study of family medicine residents

Health numeracy skills of medical students:cross-sectional and controlled before-and-after study

<p>A prospective mixed-methods study evaluating the integration of an evidence based medicine curriculum into an internal medicine residency program</p>

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