What are the effects of teaching Evidence-Based Health Care (EBHC) at different levels of health professions education? An updated overview of systematic reviews

Background Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour. Methods and findings This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up. Conclusions Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments. Study registration The protocol for the original overview was developed and approved by Stellenbosch University Research Ethics Committee S12/10/262. Update of the overview Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One. 2014;9(1):e86706. doi: 10.1371/journal.pone.0086706.

The impact of personal pseudoscientific beliefs in the pursuit for non-evidence-based health care

INTRODUCTION: Pseudoscientific beliefs are widespread in society and are influenced by several factors. The endorsement of alternative medicine treatments, mostly not evidence based, has relevant negative impacts on health care public policies. The understanding of the impact of pseudoscientific beliefs on the endorsement of alternative treatments is a relevant issue in this matter. OBJECTIVES: We aim at describing scientific and pseudoscientific beliefs and its impact on the endorsement of evidence and non-evidence-based health care treatments. METHOD: We conducted a survey in a representative sample of 2,091 participants from all Brazil geopolitical regions and 130 different cities. We measured knowledge about health treatments, including alternative medicine treatments, and trust in each treatment, if treatment had been previously sought, if treatments should be funded by the public health system, among other issues. We also measured beliefs in scientific and pseudoscientific claims using a 5-point Likert agreement scale with 9 items with two factors: Scientific beliefs and Pseudoscientific beliefs. RESULTS: Our results show that most part of the sample recognizes conventional medicine as a treatment (64.5%), but also alternative medicine practices such as homeopathy (69.2%), and spiritual therapy (68.6%). We found that support of all alternative medicine treatments is significantly predicted by pseudoscientific beliefs (betas regression coefficients ranging from .13 to .38 all p <.01). On the other hand, the support of evidence-based medicine is rooted in scientific beliefs (beta = .12, p<.01). CONCLUSION: Our results have shown a high rate of prevalence of pseudoscientific beliefs related to non-evidence-based health treatments. It also shreds a favorable evidence that general pseudoscientific beliefs are relevant to assess the endorsement of non-evidence-based healthcare.

Narrationen ermöglichen

Was ist zu diesem Thema bereits bekannt? Narrationen sind ein wichtiges Instrument im klinischen und pflegerischen Alltag. Sie schaffen für Patient_innen Raum zum Erzählen und Einordnen ihrer subjektiven Erfahrungen. Wie wird eine neue Perspektive eingebracht? Im Laufe von Professionalisierung und Fokussierung auf Evidenzbasiertheit ist das Narrative in den Hintergrund geraten – auch in der psychiatrischen Pflege. Die Forderung nach einer bewussten ‚Narrative Health Care‘ ist eine Ergänzung zur ‚Evidence-based Health Care‘ und bezieht sich auf etablierte Erkenntnisse aus der Narrationsforschung. Was sind die Auswirkungen für die Praxis? Mehr Raum für Erzählungen im pflegerischen Alltag zu schaffen, braucht nicht viel Aufwand und kann dazu beitragen, Menschen gezielter in ihrem Genesungsprozess zu unterstützen und die Reflexion der eigenen Praxis anzuregen.

Krátký test zrakově-prostorové paměti: normativní data a nové indexy učení

Neuropsychology in the Czech Republic is increasingly becoming a competitive field at the international level. However, the availability of standardized neuropsychological test methods is significantly limited compared to abroad. This limits both the further development of the field and the provision of evidence-based health care. One of the lacking methods in Czech practice is the Brief Visuospatial Memory Test-Revised (BVMT-R). The report briefly introduces this neuropsycholo­gical test.