What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review

Abstract Objective To evaluate the effects of standalone versus clinically integrated teaching in evidence based medicine on various outcomes in postgraduates. Design Systematic review of randomised and non-randomised controlled trials and before and after comparison studies. Data sources Medline, Embase, ERIC, Cochrane Library, DARE, HTA database, Best Evidence, BEME, and SCI. Study selection 23 studies: four randomised trials, seven non-randomised controlled studies, and 12 before and after comparison studies. 18 studies (including two randomised trials) evaluated a standalone teaching method, and five studies (including two randomised trials) evaluated a clinically integrated teaching method. Main outcome measures Knowledge, critical appraisal skills, attitudes, and behaviour. Results Standalone teaching improved knowledge but not skills, attitudes, or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes, and behaviour. Conclusion Teaching of evidence based medicine should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.

[1]  Ibbotson,et al.  Evaluation of a programme of workshops for promoting the teaching of critical appraisal skills , 1998, Medical education.

[2]  G. Regehr,et al.  Is a Journal Club Effective for Teaching Critical Appraisal Skills? , 1999 .

[3]  R. Taylor,et al.  A systematic review of postgraduate teaching in evidence-based medicine and critical appraisal , 2003, Medical teacher.

[4]  Mulvihill Mn.  Faculty development and resident training in epidemiology and biostatistics. , 1981 .

[5]  R Mears,et al.  A systematic review of the effectiveness of critical appraisal skills training for clinicians , 2000, Medical education.

[6]  A. Macaulay,et al.  Teaching evidence-based medical care: description and evaluation. , 2001, Family medicine.

[7]  G R Norman,et al.  Effectiveness of instruction in critical appraisal (evidence-based medicine) skills: a critical appraisal. , 1998, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[8]  P. Schoenfeld,et al.  Effect of an Evidence‐based Medicine Seminar on Participants' Interpretations of Clinical Trials: A Pilot Study , 2000, Academic medicine : journal of the Association of American Medical Colleges.

[9]  J Parkes,et al.  Teaching critical appraisal skills in health care settings. , 2001, The Cochrane database of systematic reviews.

[10]  Nelson Db,et al.  The effect of a medical journal club on residents' knowledge of clinical epidemiology and biostatistics. , 1992 .

[11]  R. Schumacher,et al.  Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit. , 2002, Journal of the Medical Library Association : JMLA.

[12]  D. Nelson,et al.  The effect of a medical journal club on residents' knowledge of clinical epidemiology and biostatistics. , 1992, Family medicine.

[13]  C. Seelig.  Affecting residents' literature reading attitudes, behaviors, and knowledge through a journal club intervention. , 1991, Journal of general internal medicine.

[14]  A T Evans,et al.  Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability. , 2000, Journal of general internal medicine.

[15]  Incorporating the views of obstetric clinicians in implementing evidence-supported labour and delivery suite ward rounds: a case study. , 2003, Health information and libraries journal.

[16]  E. DeLong,et al.  Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial. , 1988, JAMA.

[17]  S. Satya‐Murti.  Evidence-based Medicine: How to Practice and Teach EBM , 1997 .

[18]  D. H. Mellor,et al.  Real time , 1981 .

[19]  Teaching and Assessing in Clinical Practice , 2006 .

[20]  C. Seelig.  Changes Over Time in the Knowledge Acquisition Practices of Internists , 1993, Southern medical journal.

[21]  T. McGinn,et al.  A Method for Real‐time, Evidence‐based General Medical Attending Rounds , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[22]  P. Ellis,et al.  Impact of an evidence-based medicine curriculum based on adult learning theory , 1997, Journal of general internal medicine.

[23]  D. Sackett,et al.  Finding and applying evidence during clinical rounds: the "evidence cart". , 1998, JAMA.

[24]  L. Dwarakanath,et al.  Modernizing the journal club. , 2000, Hospital medicine.

[25]  J. Kellum,et al.  Teaching critical appraisal during critical care fellowship training: A foundation for evidence-based critical care medicine , 2000, Critical care medicine.

[26]  R. Ross,et al.  Introducing an Evidence‐based Medicine Curriculum into a Family Practice Residency—Is It Effective? , 2003, Academic medicine : journal of the Association of American Medical Colleges.

[27]  L. Spillane,et al.  Teaching emergency medicine residents evidence-based critical appraisal skills: a controlled trial. , 1999, Annals of emergency medicine.

[28]  Philip K. Bock.  Ethical Approval Not Required , 1994 .

[29]  J. Nicholas,et al.  Teaching evidence-based medicine to surgical subspecialty residents. , 2003, Journal of the American College of Surgeons.

[30]  L. Dwarakanath,et al.  Postgraduate journal club as a means of promoting evidence-based obstetrics and gynaecology. , 1999, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.