(IV)Integrating evidence-based medicine skills into a medical school curriculum: a quantitative outcomes assessment

ObjectivesThis research project aims to determine the potential differential impact of two curricular approaches to teaching evidence-based medicine (EBM) on student performance on an EBM assignment administered during the first year of clerkship. A meaningful result would be any statistically significant difference in scores on the assignment given to measure student performance.DesignIn order to assess and compare student learning under the different curricula, the principal investigator and a team of five faculty members blinded to assignment date and other possibly identifying details used a modified version of the previously validated Fresno rubric to retrospectively grade 3 years’ worth of EBM assignments given to students in clerkship rotations 1–3 (n=481) during the Internal Medicine clerkship. Specifically, EBM performance in three separate student cohorts was examined.SettingThe study took place at a large Midwestern medical school with nine campuses across the state of Indiana.ParticipantsStudy participants were 481 students who attended the medical school and completed the Internal Medicine clerkship between 2017 and 2019.InterventionsPrior to the inception of this study, our institution had been teaching EBM within a discrete 2-month time period during medical students’ first year. During a large-scale curricular overhaul, the approach to teaching EBM was changed to a more scaffolded, integrated approach with sessions being taught over the course of 2 years. In this study, we assess the differential impact of these two approaches to teaching EBM in the first 2 years of medical school.Main outcome measuresWe used clerkship-level EBM assignment grades to determine whether there was a difference in performance between those students who experienced the old versus the new instructional model. Clerkship EBM assignments given to the students used identical questions each year in order to have a valid basis for comparison. Additionally, we analysed average student grades across the school on the EBM portion of step 1.ResultsFour hundred and eighty-one assignments were graded. Mean scores were compared for individual questions and cumulative scores using a one-way Welch Analysis of Variance test. Overall, students performed 0.99 of a point better on the assignment from year 1 (Y1), prior to EBM curriculum integration, to year 3 (Y3), subsequent to EBM integration (p≤0.001). Statistically significant improvement was seen on questions measuring students’ ability to formulate a clinical question and critically appraise medical evidence. Additionally, on the United States Medical Licensing Examination (USMLE) step 1, we found that student scores on the EBM portion of the examination improved from Y1 to Y3.ConclusionsResults of this study suggest that taking a scaffolded, curriculum-integrated approach to EBM instruction during the preclinical years increases, or at the very least does not lessen, student retention of and ability to apply EBM concepts to patient care. Although it is difficult to fully attribute students’ retention and application of EBM concepts to the adoption of a curricular model focused on scaffolding and integration, the results of this study show that there are value-added educational effects to teaching EBM in this new format. Overall, this study provides a foundation for new research and practice seeking to improve EBM instruction.Trial registration numberIRB approval (Protocol number 1907054875) was obtained for this study.

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From Drug Literature Evaluation to Evidence-Based Medicine: Transforming the Focus of a First Year Pharmacy Curriculum

INNOVATIONS in pharmacy ◽

10.24926/iip.v7i2.425 ◽

2016 ◽

Vol 7 (2) ◽

Cited By ~ 3

Author(s):

Shannon Reidt ◽

Keri Hager ◽

James Beattie ◽

Amy Pittenger ◽

Maureen Smith ◽

...

Keyword(s):

Student Performance ◽

Student Perceptions ◽

Evidence Based Medicine ◽

Integrated Design ◽

First Year ◽

Evidence Based ◽

And Performance ◽

Pharmacy Curriculum ◽

Based Medicine

This case study describes a longitudinal curricular sequence implemented to teach evidence-based medicine (EBM) skills. The longitudinal sequence is innovative in its approach, design, and assessment of EBM. This approach moves away from the conventional strategy of teaching drug information and drug literature evaluation as stand-alone courses and instead embraces the EBM Framework and its use in the context of authentic problem solving. The EBM Framework—Ask, Acquire, Appraise, and Apply—was used as the basis for defining seven EBM skills. These skills were targeted in the evidence-based, integrated design of 17 learning episodes delivered with eight faculty members through six courses in the first year. Student perceptions of relevance of EBM and performance on assessments and learning activities throughout the sequence suggest that integrating EBM across the first year of the curriculum is an effective strategy for teaching EBM skills. Three themes emerged from analysis of the data and experience, including the need for: a strong teaching team, a whole task approach with a focus on solving authentic problems, and care in interpreting the progression of assessments and patterns of student performance. Through instructor observations and peer review, the longitudinal sequence has been refined and has had an impact on the rest of the curriculum. Type: Case Study

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Using Team-Based Learning to Teach Evidence-Based Medicine to First-Year Residents

Acta Facultatis Medicae Naissensis ◽

10.2478/afmnai-2019-0006 ◽

2019 ◽

Vol 36 (1) ◽

pp. 60-68

Author(s):

Mandana Akbarinejad Mousavi ◽

Mitra Amini ◽

Somayeh Delavari ◽

Ali Seifi

Keyword(s):

Medical School ◽

Evidence Based Medicine ◽

Instructional Strategy ◽

Medical Residents ◽

P Value ◽

First Year ◽

Evidence Based ◽

Significant Difference ◽

Team Based Learning ◽

Based Medicine

Summary Team-based learning (TBL) is a well-established instructional strategy that provides students with the chance to apply conceptual knowledge through a series of actions, including pre-class, individual, team class activity, and immediate feedback. The purpose of the present study was to introduce a course of teaching the evidence-based medicine (EBM) to all first-year medical residents in different disciplines at Shiraz Medical School in Iran country using the TBL instructional strategy. The sample included 86 medical residents at Shiraz Medical School. This study had a quasi-experimental design and was conducted in 12 sessions of evidence-based medicine (EBM) based on team-based learning (TBL) strategy. The obtained data were analyzed using SPSS software. In all sections, the results of Individual Readiness Assurance Tests (IRATs) and Group Readiness Assurance Tests (GRATs) were added and calculated. Cronbach’s alpha test was implemented to evaluate the reliability of the questionnaires. For the descriptive analysis of data, descriptive statistics were used. ANOVA and T-test were used for analytic analysis. There was a significant difference in answering the questions between individual (3.73 ± 2.33) and group (4.71 ± 2.29) stages. Residents gained higher average grades on working in the team (P-value < 0.02). Results of residents’ response about satisfaction questionnaire are shown that the best scores belong to group activities in TBL. The results of this study showed that TBL could be used as an effective method for residents’ education in different disciplines.

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Evaluation of a Longitudinal Medical School Evidence-Based Medicine Curriculum: A Pilot Study

Journal of General Internal Medicine ◽

10.1007/s11606-008-0625-x ◽

2008 ◽

Vol 23 (7) ◽

pp. 1057-1059 ◽

Cited By ~ 19

Author(s):

Colin P. West ◽

Furman S. McDonald

Keyword(s):

Pilot Study ◽

Medical School ◽

Evidence Based Medicine ◽

Evidence Based ◽

Based Medicine

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Lessons from across the pond: Student perspectives on the Internal Medicine clerkship experience at an Irish and Canadian medical school

MedEdPublish ◽

10.15694/mep.2020.000016.1 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Ryan Taylor Sless ◽

Nathaniel Edward Hayward ◽

Paul MacDaragh Ryan ◽

Adam Kovacs-Litman ◽

Umberin Najeeb

Keyword(s):

Internal Medicine ◽

Medical School ◽

Student Perspectives ◽

Medicine Clerkship ◽

Canadian Medical School ◽

Internal Medicine Clerkship

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The Fall of Psychopharmacology

10.1093/med/9780197574430.003.0020 ◽

2021 ◽

pp. 305-322

Author(s):

Edward Shorter

Keyword(s):

New Zealand ◽

Pharmaceutical Industry ◽

Medical School ◽

Evidence Based Medicine ◽

Mood Stabilizers ◽

Scientific Concept ◽

Evidence Based ◽

Clinical Neuroscience ◽

Based Medicine

In 2012, Mickey Nardo forecast the end of an era during the height of the Age of Psychopharmacology and Clinical Neuroscience. Skeptical observers like Nardo asked the disquieting question of why SSRI/SNRIs, SGAs, and mood stabilizers were needed when psychiatrists were just prescribing ineffective drugs for non-existent conditions. Susanna Every-Palmer, a psychiatrist at the Otago Medical School in New Zealand, argued that evidence-based medicine in general was being discredited by the invasion of the pharmaceutical industry. Psychopharmacology was doomed as a scientific concept when it became a vehicle for promoting the pharmaceutical industry. Psychopharmacology’s scientific concept died when it became a trope for selling drugs.

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A Novel Approach to Incorporating Evidence-based Medicine Into an Emergency Medicine Clerkship

Academic Emergency Medicine ◽

10.1111/acem.12089 ◽

2013 ◽

Vol 20 (3) ◽

pp. 295-299 ◽

Cited By ~ 2

Author(s):

Jonathan Snashall ◽

Malika Fair ◽

James Scott

Keyword(s):

Emergency Medicine ◽

Evidence Based Medicine ◽

Evidence Based ◽

Medicine Clerkship ◽

Novel Approach ◽

Based Medicine

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The Impact of Increasing Medical School Class Size on Clinical Clerkships: A National Survey of Internal Medicine Clerkship Directors

Academic Medicine ◽

10.1097/acm.0b013e31816bde59 ◽

2008 ◽

Vol 83 (5) ◽

pp. 432-437 ◽

Cited By ~ 10

Author(s):

Paul A. Hemmer ◽

Tod Ibrahim ◽

Steven J. Durning

Keyword(s):

Internal Medicine ◽

Medical School ◽

National Survey ◽

Class Size ◽

Medicine Clerkship ◽

School Class ◽

Internal Medicine Clerkship ◽

Clinical Clerkships ◽

The Impact

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Multiple Medical Students on a Clerkship Team: Do They Affect Each Others’ Grades?

10.21203/rs.3.rs-44283/v1 ◽

2020 ◽

Author(s):

Krishan K. Sharma ◽

Yuchiao Chang ◽

Eli Michael Miloslavsky

Keyword(s):

Internal Medicine ◽

Medical Students ◽

Student Performance ◽

Student Perceptions ◽

Response Rate ◽

Medicine Clerkship ◽

Internal Medicine Clerkship ◽

Student Grades ◽

Attending Physicians ◽

The Impact

Abstract Background Medical students are often paired together on clinical teams during their clerkships, but the effect of this practice on student performance is unknown. The primary objectives of this study were (1) to retrospectively assess whether students paired together on a medical team during their Internal Medicine sub-internship affected each other’s grade and (2) to survey medical students’ perceptions on the impact of pairing on their evaluations. Methods We examined clerkship grades of 186 student-pairs at 3 sub-internship hospital sites of Harvard Medical School from 2013-2017. To evaluate student perceptions we administered a survey to the graduating class of 2018. Results There was no significant deviation between the expected and observed distribution of student grades (p=0.39) among 186 student pairs, suggesting that pairing had no meaningful effect on the sub-internship grade. We also saw no effect when controlling for prior internal medicine clerkship performance (p=0.53). We then surveyed students in the 2018 graduating class assessing student perceptions on pairing. Of the 99 respondents (59% response rate), 90% and 87% of respondents felt that being paired affected their evaluations by resident and attending physicians, respectively. Conclusions Our analysis suggests that paired medical students do not meaningfully affect each others’ grades, despite the majority of surveyed students believing that being paired affects their evaluations. Awareness of student perceptions regarding pairing can inform clerkship structure and be utilized to address student concerns.

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