What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews

Abstract

Background Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour. Methods and findings This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up. Conclusions Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments. Study registration The protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262. Update of the overview Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: 10.1371/journal.pone.0086706.

Has anything changed in Evidence-Based Medicine?

“… [38] Therefore, several initiatives as for example the European Union Evidence-Based Medicine project, [39] the teaching programs of the Oxford Centre for EBM and McMaster University to disseminate EBM teaching, the uptake of teaching resources is low. [ 40 , 41 ] Several strategies both face-to-face and virtual have being implemented to more effectively teach EBM including journal clubs, lectures, workshops, group work, seminars, collaboration with librarians and newer methods as well including simulations, gaming and the use of mobile phones. [40] Sadly, the bedside practice of EBM by is “irregular” at best, and even those “trained”, do not exhibit a change of behaviour giving a reason of “lack of skills”.…”

“…[ 40 , 41 ] Several strategies both face-to-face and virtual have being implemented to more effectively teach EBM including journal clubs, lectures, workshops, group work, seminars, collaboration with librarians and newer methods as well including simulations, gaming and the use of mobile phones. [40] Sadly, the bedside practice of EBM by is “irregular” at best, and even those “trained”, do not exhibit a change of behaviour giving a reason of “lack of skills”. [42] Talking about change , over 300 articles have been published on the teaching of EBM, [43] and despite the vast amount of literature, the teaching of EBM remains problematic.…”

“… [42] Talking about change , over 300 articles have been published on the teaching of EBM, [43] and despite the vast amount of literature, the teaching of EBM remains problematic. [ [40] , [41] , [42] , 44 ] There is ongoing discussion and debate with no universal consensus regarding the best approach as the acquisition of skills in EBM is fairly complex, related to contextual factors, needs clinical integration and positive role models. [42] It looks like the change from theory to effective practice in the teaching of EBM has not been accomplished.…”

Evidence implementation across Europe: the challenge of collaboration during the pandemic

“…Healthcare professionals across Europe need to improve their experience and skills of getting research into practice. 3 Implementing the best available evidence into practice is a crucial part of the whole EBHC approach, regardless of field, context or country. For this project, we decided to use our strong international cooperation within the JBI European collaboration and start the first action focused on exchange experiences and 'knowhow' in implementation science internationally.…”

“…In contrast, there are still some healthcare areas where there is a lack of research evidence, and healthcare decisions continue to be based on expert opinion alone. Healthcare professionals across Europe need to improve their experience and skills of getting research into practice 3 …”