scholarly journals Incorporating Evidence Based Medicine in Medical Education and Health Care

2015 ◽  
Vol 101 (3) ◽  
pp. 18-23
Author(s):  
Bhaskaran Unnikrishnan ◽  
Darshan Bhagwan ◽  
Akshay Sethi ◽  
Rekha Thapar ◽  
Prasanna Mithra ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Medical Curriculum ◽  
Evidence Based ◽  
Cross Sectional ◽  
Good Level ◽  
Education And Health ◽  
Based Medicine

A facility-based cross sectional study was carried out among 188 doctors working at the Kasturba Medical College in Mangalore, India, to assess the perception and practice of evidence based medicine (EBM) among medical professionals. Data was collected using a pre-tested questionnaire and results obtained were expressed in percentages. Results: The mean age of participants was 35 ± 8.33 years. A higher proportion of participants (n=182, 96.8%) referred to textbooks for information for clinical decision making. A majority of the participants (n=180, 95.8%) opined that evidence based medicine should be included in a medical curriculum. More than half of the participants (n=98, 52.1%) used PubMed. A majority (n=150, 79.8%) of the participants had a good level of self-rated confidence in evaluating research, while 55.3% (n=104) of the participants had a good level of self-rated confidence in their ability to conduct clinical appraisals. Lack of time and insufficient EBM skills were the major perceived barriers to practicing evidence based medicine. Conclusion: Positive attitudes and higher awareness regarding EBM among doctors in the present study compared to other reported literature is an encouraging finding. Medical regulators must utilize the best available evidence and experience in formulating policy on medical education and health care.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

Application of research evidence in clinical practice

2020 ◽  
pp. 73-79
Author(s):  
Andrea Cipriani ◽  
Stefan Leucht ◽  
John R. Geddes
Keyword(s):  
Health Care ◽  
Evidence Based Medicine ◽  
Research Evidence ◽  
Clinical Decision Making ◽  
Evidence Based ◽  
Individual Patient Level ◽  
Patient Values ◽  
The Individual ◽  
Theory Of Evidence ◽  
Based Medicine

The aim of evidence-based medicine is to integrate current best evidence from research with clinical expertise and patient values. However, it is known that one of the major challenges for clinicians is to move from the theory of evidence-based medicine to the practice of it. Evidence-based practice requires new skills of the clinician, including framing a clear question based on a clinical problem, searching and critically appraising the relevant literature, and applying the findings to routine clinical decision-making, ideally at the individual patient level. Scientific evidence is increasingly accessible through journals and information services that should combine high-quality evidence with information technology. However, the process is not straightforward, as there are several barriers to the successful application of research evidence to health care. This chapter discusses both the prospects for harnessing evidence to improve health care and the problems that clinicians will need to overcome to practise ‘evidence-based-ly’.

scholarly journals Development and evaluation of an evidence-based medicine module in the undergraduate medical curriculum

2020 ◽  
Author(s):  
Abeer Salem Al Shahrani
Keyword(s):  
Medical Students ◽  
Study Design ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Medical Curriculum ◽  
Control Group ◽  
Evidence Based ◽  
Fresno Test ◽  
Post Test ◽  
Based Medicine

Abstract Background: Evidence-based medicine (EBM) is a core competence in both undergraduate and postgraduate medical curricula. However, its integration into curricula varies widely. Our study will help medical colleges develop, implement and evaluate their EBM courses. We assessed the effectiveness of workshops in improving critical appraisal skills among medical students.Methods: A before-and-after study design without a control group was used. A 5-week short EBM module including lectures, workshops, and online search sessions was conducted with 52 fourth-year medical students during their primary healthcare course at the College of Medicine, Princess Nourah bint Abdulrahman University. Statistical analysis was performed using SPSS statistical software (version 20, SPSS Inc., Chicago, US). Parametric tests as well as Student’s paired t-test for pre- and post-test comparisons were used.Results: Forty-nine (49) participants completed the pre- and post-training Fresno tests, and 44.9% of the participants had a GPA of 4.0 or higher. The mean Fresno test score increased from 45.63 (SD 21.89) on the pre-test to 64.49 (SD 33.31) on the post-test, with significant improvements in the following items: search strategies, relevance, internal validity, magnitude and significance of results, statistical values of diagnosis studies (sensitivity, specificity, and LR), statistical values of therapy studies (ARR, RRR, and NNT), and best study design for diagnosis and prognosis (P<0.05).Conclusion: This study supports that a short course in EBM that is incorporated into the undergraduate curriculum, especially in the clinical years, might be effective in improving medical students’ knowledge and skills in EBM. However, prospective studies are necessary to assess the long-term impact of these interventions and ultimately their effectiveness for clinical decision making. Trial registration: not applicable

scholarly journals A cross-sectional survey on academic librarian involvement in evidence-based medicine instruction within undergraduate medical education programs in Canada

2020 ◽  
Vol 41 (3) ◽  
Author(s):  
Zahra Premji ◽  
Kaitlin Fuller ◽  
Rebecca Raworth
Keyword(s):  
Medical Education ◽  
Undergraduate Medical Education ◽  
Evidence Based Medicine ◽  
Evidence Based ◽  
Educational Strategies ◽  
Education Programs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
School Faculty ◽  
Based Medicine

Introduction: The purpose of this study was to determine the range of involvement of Canadian academic medical librarians in teaching evidence-based medicine (EBM) within the undergraduate medical education (UME) curriculum. This study articulates the various roles that Canadian librarians play in teaching EBM within the UME curriculum, and also highlights their teaching practices. Methods: An electronic survey was distributed to a targeted sample of academic librarians currently involved in UME programs in Canadian medical schools. Results: 12 respondents (including one duplicate response) representing ten schools responded to this survey. 7 of 10 respondents were involved in EBM instruction, 3 of 10 institutions had a dedicated EBM course. Librarians were involved in a variety of roles, and often co-created and co-delivered content along with medical school faculty, and were present on course committees. They used a variety of educational strategies, incorporated active learning, as well as online modules. Discussion/Conclusion: The data highlighted the embedded nature of EBM instruction in undergraduate medical education programs in Canada. It also showed that librarians are involved in EBM instruction beyond the second step of EBM; acquiring or searching the literature.

scholarly journals Examining aptitude and barriers to evidence-based medicine among trainees at an ACGME-I accredited program

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Mai A. Mahmoud ◽  
Sa’ad Laws ◽  
Antoun Kamel ◽  
Dabia Al Mohanadi ◽  
Ahmed Al Mohammed ◽  
...  
Keyword(s):  
Medical Education ◽  
Middle East ◽  
Graduate Medical Education ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Educational Background ◽  
Average Score ◽  
Evidence Based ◽  
Graduate Medical ◽  
Based Medicine

Abstract Background The aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients’ outcome (Profetto-McGrath J, J Prof Nurs Off J Am Assoc Coll Nurs 21:364-371, 2005). Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients’ care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East. Methods Clinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees’ attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed. Results The average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM. Conclusions While it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice.

scholarly journals Evidence Based Medicine Teaching in Undergraduate Medical Education: A Literature Review

2012 ◽  
Vol 7 (3) ◽  
pp. 98 ◽  
Author(s):  
Misa Mi
Keyword(s):  
Medical Education ◽  
Undergraduate Medical Education ◽  
Evidence Based Medicine ◽  
Medical Curriculum ◽  
The United States ◽  
Evaluation Methods ◽  
Cochrane Library ◽  
Evidence Based ◽  
Contact Hours ◽  
Based Medicine

Objectives – To determine the year when evidence based medicine (EBM) was introduced and the extent to which medical students were exposed to EBM in undergraduate medical education and to investigate how EBM interventions were designed, developed, implemented, and evaluated in the medical curriculum. Methods – A qualitative review of the literature on EBM interventions was conducted to synthesize results of studies published from January 1997 to December 2011. A comprehensive search was performed on PubMed, CINAHL, Web of Science, Cochrane Library, ProQuest Dissertations & Theses, PsycINFO, and ERIC. Articles were selected if the studies involved some form of quantitative and qualitative research design. Articles were excluded if they studied EBM interventions in medical schools outside the United States or if they examined EBM interventions for allied health profession education or at the levels of graduate medical education and continuing medical education. Thirteen studies which met the selection criteria were identified and reviewed. Information was abstracted including study design, year and setting of EBM intervention, instructional method, instruction delivery format, outcome measured, and evaluation method. Results – EBM was introduced to preclinical years in three studies, integrated into clinical clerkship rotations in primary care settings in eight studies, and spanned preclinical and clinical curricula in two studies. The duration of EBM interventions differed, ranging from a workshop of three student contact hours to a curriculum of 30 student contact hours. Five studies incorporated interactive and clinically integrated teaching and learning activities to support student learning. Diverse research designs, EBM interventions, and evaluation methods resulted in heterogeneity in results across the 13 studies. Conclusions – The review reveals wide variations in duration of EBM interventions, instructional methods, delivery formats for EBM instruction, implementation of an EBM intervention, outcomes measured, and evaluation methods, all of which remain relevant issues for further research. It is important for medical educators and health sciences librarians to attend to these issues in designing and delivering a successful EBM intervention in the undergraduate medical curriculum.

USAGE OF INTERACTIVE EDUCATION METHODS DURING INTERNAL MEDICINE TEACHING OF 6-YEAR STUDENTS

2019 ◽  
pp. 191-193
Author(s):  
Н. Б. Тимочко
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Medical Education ◽  
Evidence Based Medicine ◽  
Medical Practitioner ◽  
Evidence Based ◽  
Main Body ◽  
Interactive Education ◽  
Based Medicine

The aim of the work is to analyze interactive education methods during internal medicine teaching of 6-years students of the Faculty of Medicine. Main body. The training of a physician in modern conditions has to correspond as to the problems of health care, as well to society at large, upon that a modern physician has to be not only competent in the area of their restricted professional tasks, but also to be well-versed in questions of diagnostics and treatment, basics of evidence-based medicine, to stay tuned in interdisciplinary branches. Quality of medical education will influence quality of medical aid in Ukraine. Conclusion. Introduction of interactive education techniques will enable to get a high qualified medical practitioner in the future.

scholarly journals Development and evaluation of an evidence-based medicine module in the undergraduate medical curriculum

2020 ◽  
Author(s):  
Abeer Salem Al Shahrani
Keyword(s):  
Medical Students ◽  
Study Design ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Medical Curriculum ◽  
Control Group ◽  
Evidence Based ◽  
Fresno Test ◽  
Post Test ◽  
Based Medicine

Abstract Background: Evidence-based medicine (EBM) is a core competence in both undergraduate and postgraduate medical curricula. However, its integration into curricula varies widely. Our study will help medical colleges develop, implement and evaluate their EBM courses. We assessed the effectiveness of workshops in improving critical appraisal skills among medical students. Methods A before-and-after study design without a control group was used. A 5-week short EBM module including lectures, workshops, and online search sessions was conducted with 52 fourth-year medical students during their primary healthcare course at the College of Medicine, Princess Nourah bint Abdulrahman University. Statistical analysis was performed using SPSS statistical software (version 20, SPSS Inc., Chicago, US). Parametric tests as well as Student’s paired t-test for pre- and post-test comparisons were used. Results Forty-nine (49) participants completed the pre- and post-training Fresno tests, and 44.9% of the participants had a GPA of 4.0 or higher. The mean Fresno test score increased from 45.63 (SD 21.89) on the pre-test to 64.49 (SD 33.31) on the post-test, with significant improvements in the following items: Searching strategies, Relevance, Internal validity, Magnitude & significance of results, Statistical values of diagnosis studies (sensitivity, specificity, and LR), Statistical values of therapy studies (ARR, RRR, and NNT), and Best study design for diagnosis and prognosis (P < 0.05). Conclusion This study supports that short course in EBM that is incorporated into the undergraduate curriculum especially in the clinical years might be effective in improving medical students’ knowledge and skills in EBM. However, prospective studies are necessary to assess the long-term impact of these interventions and ultimately their effectiveness for clinical decision making.

scholarly journals Examining aptitude and barriers to Evidence Based Medicine among trainees at an ACGME-I accredited program

2020 ◽  
Author(s):  
Mai Mahmoud ◽  
Saad Laws ◽  
Antoun Kamal ◽  
Dabia Al Mohanadi ◽  
Ahmed Al Mohammed ◽  
...  
Keyword(s):  
Medical Education ◽  
Middle East ◽  
Graduate Medical Education ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Educational Background ◽  
Average Score ◽  
Evidence Based ◽  
Graduate Medical ◽  
Based Medicine

Abstract BackgroundThe aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients’ outcome1. Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients’ care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East. MethodsClinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees’ attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed.Results The average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM. ConclusionsWhile it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice.

scholarly journals Examining aptitude and barriers to Evidence Based Medicine among trainees at an ACGME-I accredited program

2020 ◽  
Author(s):  
Mai Mahmoud ◽  
Saad Laws ◽  
Antoun Kamal ◽  
Dabia Al Mohanadi ◽  
Ahmed Al Mohammed ◽  
...  
Keyword(s):  
Medical Education ◽  
Middle East ◽  
Graduate Medical Education ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Educational Background ◽  
Average Score ◽  
Evidence Based ◽  
Graduate Medical ◽  
Based Medicine

Abstract BackgroundThe aims of Evidence-Based medicine (EBM) are to promote critical thinking and produces better patients’ outcome1. Accreditation Council for Graduate Medical Education (ACGME) competencies require trainees to locate, appraise and apply clinical evidence to patients’ care. Despite the emphasis that ACGME place on EBM, few organizations provide adequate training in EBM. This is even more critical in regions where medical trainees matriculate from diverse backgrounds of undergraduate medical education, where EBM may not be emphasized nor taught at all. EBM practice has a history of research in the West, however, EBM has not been widely studied in the Middle East. MethodsClinicians and trainees at Hamad Medical Corporation (HMC) matriculate from many countries in the Middle East and North Africa (MENA) and Asia. Because trainees in Graduate Medical Education (GME) come to HMC from a variety of geographic backgrounds, it is assumed that they also have a variety of experiences and aptitudes in EBM. To assess trainees EBM attitudes and knowledge in the internal medicine department at HMC in Doha, Qatar, the authors surveyed residents and fellows using a two-part survey. The first part was adapted from the evidence-based practice inventory by Kaper to assess trainees’ attitudes and perceptions of EBM. Trainees were also asked to complete the Assessing Competency in Evidence Based Medicine (ACE) tool to evaluate their aptitude in different elements of EBM. The results from the two parts were analyzed.Results The average score on the ACE tool among the participants was 8.9 (±1.6). Most participants rated themselves as beginners or intermediate in their EBM capabilities. Higher ACE scores were observed from participants with educational background from South Asia, and among those with more favorable attitudes towards EBM. There was no clear pattern that early incorporation of EBM into practice will result in better ACE score. Participants also reported reasonable abilities in EBM tasks and a favorable work atmosphere for EBM implementation. Lack of knowledge, resources, and time were the most reported barriers to utilizing EBM. ConclusionsWhile it is clear that participants are enthusiastic about EBM and see it as a useful method for clinical decision making, their aptitude in EBM is not optimal and there are gaps and barriers for them to practice. Although structured EBM teaching is usually a part of the graduate training, the institutions should make sure that trainees have the needed resources and the protected time to effectively implement learning and practicing EBM

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