Using Evidence to Inform Risk or Harm Decisions

Abstract

Abstract Introduction Numerous studies have demonstrated that many physicians lack fundamental skills in interpreting and using clinical care evidence. We hypothesized that building a foundation for evidence-based medicine (EBM) prior to the clinical years would provide an initial scaffold that could be integrated during clinical training. Many schools have interpreted LCME standard ED-17 as synonymous with instruction in EBM. Methods This was one of nine modules in EBM skills for first-year and second-year medical students, who were novices in EBM knowledge. The two-part module began with a 2-hour, in-class didactic covering the fundamental features of risk and harm studies, including internal study validity, and study results. Between 1 and 14 days later, students then participated in a 2-hour interactive large-group EBM exercise during which they applied their knowledge and practiced forming judgments for overall study validity. The large-group exercise is based on principles of team-based learning (TBL), but does not follow them exactly. Results We performed a pre-post assessment of alternative items (10 pre, 12 post) covering the same objectives. The preassessment scores were 175 correct and 215 incorrect (difficulty 44.87%). Postassessment scores were 421 correct and 47 incorrect (difficulty 89.96%). Discussion The mode of instruction is highly adaptable. In previous years, the module followed strict TBL pedagogy for the application exercise, and this EBM exercise can easily be converted back to a traditional TBL by having teams simultaneously report answers using whiteboards or flipcharts and then debating their choices. In addition, the initial didactic session can be prerecorded for students to review before class.

Keywords

• TBL
• Team-Based Learning
• EBM
• Risk
• Harm
• Evidence-Based Medicine