Abstract
OBJECTIVES: To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal.
DESIGN: Firm-based, controlled trial.
SETTING: Urban public hospital.
PARTICIPANTS: Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group.
INTERVENTION: An EBM course, taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills.
MEASUREMENTS AND MAIN RESULTS: The main outcome measure was performance on an EBM skills test that was administered four times over 11 months: at baseline and at three time points postcourse. Postcourse test 1 assessed the effectiveness of the intervention in the experimental group (primary outcome); postcourse test 2 assessed the control group after it crossed over to receive the intervention; and postcourse test 3 assessed durability. Baseline EBM skills were similar in the two groups. After receiving the EBM course, the experimental group achieved significantly higher postcourse test scores (adjusted mean difference, 21%; 95% confidence interval, 13% to 28%; P<.001). Postcourse improvements were noted in three of the four EBM skill domains (formulating questions, searching, and quantitative understanding [P<.005 for all], but not in critical appraisal skills [P=.4]). After crossing over to receive the educational intervention, the control group achieved similar improvements. Both groups sustained these improvements over 6 to 9 months of follow-up.
CONCLUSIONS: A brief structured educational intervention produced substantial and durable improvements in residents’ cognitive and technical EBM skills.
Similar content being viewed by others
References
McAlister FA, Graham I, Karr GW, Laupacis A. Evidence-based medicine and the practicing clinician. J Gen Intern Med. 1999;14:236–42.
Green ML, Ellis PJ. Impact of an evidence-based medicine curriculum based on adult learning theory. J Gen Intern Med. 1997;2:742–50.
Williams BC, Stern DT. Exploratory study of residents’ conceptual framework for critical appraisal of the literature. Teaching and Learning in Medicine. 1997;9:270–75.
Stern DT, Linzer M, O’Sullivan PS, Weld L. Evaluating medical residents’ literature appraisal skills. Acad Med. 1995;70:152–4.
Kitchens JM, Pfeifer MP. Teaching residents to read the medical literature: a controlled trial of curriculum in critical appraisal/clinical epidemiology. J Gen Intern Med. 1989;4:384–7.
Linzer M, Brown JT, Frazier LM, DeLong ER, Siegel WC. Impact of a medical journal club on housestaff reading habits, knowledge and critical appraisal: a randomized controlled trial. JAMA. 1988;260:2537–41.
Seelig CB. Affecting residents’ literature reading attitudes, behaviors, and knowledge through a journal club intervention. J Gen Intern Med. 1991;6:330–4.
Linzer M, DeLong ER, Hupart KH. A comparison of two formats for teaching critical reading skills in a medical journal club. J Med Educ. 1987;62:690–2.
Green ML. Graduate medical education training in clinical epidemiology, critical appraisal and evidence-based medicine: a critical review of curricula. Acad Med. 1999;74:686–94.
Datta D, Adler J, Sullivant J, Leipzig RM. Test instruments for assessing evidence-based medicine competency. J Gen Intern Med. 1999;14(suppl 2):132. Abstract.
Sackett DL, Rosenberg WMC. On the need for evidence-based medicine. J R Soc Med. 1995;88:620–4.
Sackett DL, Rosenberg WMC. On the need for evidence-based medicine. Health Econ. 1995;4:249–54.
Sackett DL, Rosenberg WMC. On the need for evidence-based medicine. J Public Health Med. 1995;17:330–4.
Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. Edinburgh, UK: Churchill Livingstone; 1997:3.
Richardson WS, Wilson MC, Nishikawa J, Hayward RSA. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123:A12–3. Editorial.
Haynes RB, Sackett DL, Muir-Grey JA, Cook DL, Guyatt GH. Transferring evidence from research in to practice: 2. Getting the evidence straight. ACP J Club. 1997;126:A14–6. Editorial.
Guyatt GH, Cook DJ, Jaeschke R. How should clinicians use the results of randomized trials? ACP J Club. 1995;122:A12–3. Editorial.
VanWeel C, Knottnerus JA. Evidence-based interventions and comprehensive treatment. Lancet. 1999;353:916–8.
Culpepper L, Gilbert TT. Evidence and ethics. Lancet. 1999; 353:829–31.
Mant D. Can randomized trials inform clinical decisions about individual patients? Lancet. 1999;353:743–6.
Rosser WW. Application of evidence from randomized controlled trials to general practice. Lancet. 1999;353:661–4.
Linzer M. Critical appraisal: more work to be done. J Gen Intern Med. 1990;5:457–9.
Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidence-based medicine) skills: a critical appraisal. CMAJ. 1998;158:177–81.
Sackett DL. Teaching critical appraisal: no quick fixes. CMAJ. 1998;158:203–4. Editorial.
Ghali WA, Lesky LG, Hershmann WY. The missing curriculum. Acad Med. 1998;737:734–6.
Reilly B, Lemon M. Evidence-based morning report: a popular new format in a large teaching hospital. Am J Med. 1997; 103:419–26.
Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient medicine is evidence based. Lancet. 1995;346:407–10.
Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized controlled trials and recommendations of clinical experts. Treatments for myocardial infarctions. JAMA. 1992;268:240–8.
Weingarten S, Stone E, Hayward R, et al. The adoption of preventive care guidelines by primary care physicians: do actions match intentions? J Gen Intern Med. 1995;10:138–44.
Author information
Authors and Affiliations
Corresponding author
Additional information
The Department of Medicine of Cook County Hospital provided all funding and support for this project.
Rights and permissions
About this article
Cite this article
Smith, C.A., Ganschow, P.S., Reilly, B.M. et al. Teaching residents evidence-based medicine skills. J GEN INTERN MED 15, 710–715 (2000). https://doi.org/10.1046/j.1525-1497.2000.91026.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2000.91026.x