MedEdPORTAL (Apr 2014)
An Integrated Practical Evidence-Based Medicine Curriculum, Critical Appraisal: Therapy
Abstract
Abstract Introduction Rather than memorizing facts and creating ingrained habits, medical residents and students in training must learn to be flexible in their clinical approach, integrating best evidence as it becomes available. Typically, in the majority of pediatric training programs, evidence-based medicine (EBM) is taught in the context of a journal club, which may not develop the skills needed to integrate EBM into one's own clinical practice. This small-group session reintroduces residents to basic EBM principles and gives instruction regarding the appraisal of an article about a new theory. Three additional sessions in this series discuss how to develop an answerable clinical question, how to utilize evidence-based resources and how to appraise an article about a diagnostic test have been described. Methods Learners are provided with a reintroduction to basic EBM principles, before being introduced to therapy-related articles, validity measures, results analysis, and clinical application. They then review two example cases before a wrap-up debriefing and homework assignment. Results Evaluation of the first two cohorts of residents participating in our curriculum revealed overall improvement in EBM knowledge. Participants were evaluated using a quiz comprised of true/false, matching, and multiple choice questions both prior to the initiation and at the completion of all small group sessions. For Cohort 1, the participant group scored marginally higher overall than compared to non-participant controls (M = 18.8 ± 2.5 vs. 15.9 ± 2.3, p = .15). Participant scores were significantly higher than control scores on the short-answer questions only (M = 3.8 ± 0.4 vs. 3.2 ± 0.5, p = .03). Cohort 2 (n = 12) took the same EBM review quiz before the start and after the completion of their first year. Overall average scores showed improvement from precourse 10.4 ± 5.1 to postcourse 13.3 ± 3.4 (p = .01). Discussion This curriculum was designed for use with pediatric residents. While some of the sample cases and examples are pediatric-focused, the principles and skills are applicable to residents training in any specialty. The classes could easily be adapted for use with medical students with some clinical experience in their last two years of training.
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