Methods for teaching EBM: what’s the best bet?

“Blog entry written on: (IV)Integrating evidence-based medicine skills into a medical school curriculum: a quantitative outcomes assessment, (bmjebm-2020-111391).

Authors: Laura Menard, Amy E Blevins, Daniel J Trujillo, Kenneth H Lazarus


As medical research continues to accelerate, the need for trainees to demonstrate progressive competency of evidence-based medicine (EBM) skills will only continue to grow. Medical students and practicing clinicians should be able to ask patient-centered research questions, find and analyze the best and most up-to-date evidence, and apply their findings to patient care. At the Indiana University School of Medicine (IUSM), we conducted a study entitled “Integrating Evidence-Based Medicine Skills into a Medical School Curriculum: A Quantitative Outcomes Assessment” (article ID bmjebm-2020-111391.R1) which found a scaffolded, integrated EBM curriculum helps students execute key EBM skills in their clerkship years better than a one-shot approach to teaching this content.

In spite of the fact that EBM is covered to some extent in most medical school curricula, surveys have found no standardized set of best practices currently exist for teaching EBM skills to medical students in their preclinical years. Evaluations of EBM skills often rely on students’ self-reported assessment of their abilities, which can be exaggerated or inaccurate. Many approaches have been reported as case studies, but a systematic review shows that long-term results of these interventions can be difficult to document and comparative studies are few and far between.

A common approach to teaching EBM seems to be the one-shot, wherein students learn EBM during an isolated course or session. However, we were interested in attempting to scaffold our EBM curriculum, giving students the chance to learn and apply progressively more complex EBM skills over the course of several years.

A large-scale curricular overhaul gave IUSM the perfect opportunity to update our approach to delivering an EBM curriculum in the pre-clinical years. Between 2017-2019, we updated the curricular delivery modality for EBM in the first two years of medical school, shifting from an isolated short course to a scaffolded, progressive design which was integrated into existing foundational courses. This change allowed us to quantify the differences in student EBM performance, measured by an assignment given in the first year of clerkships to all students.

In the students who experienced the updated curriculum compared to those who did not, we found modest but statistically significant gains in students’ ability to perform several key EBM tasks during their first year of clerkships. These students performed almost a full point better overall out of an 18-point scale on the EBM assignment used to measure competency. They also showed superior ability to formulate a patient-focused question (PICO) and perform a critical appraisal of literature for application to a patient case. Compared to their peers who experienced the isolated EBM curricular delivery, students in the updated curricular cohort also scored better on the EBM portion of the United States Medical Licensing Examination Step 1, which all US medical students are required to take before entering the clinical phase of their education.

Our study does have some limitations, which we plan to address in our future plans. We only analyzed 481 student assignments, a sample which did not include every assignment completed across the three years. Due to time constraints, we also assigned only one grader to each assignment. In a future study, we plan to analyze a larger sample and assign multiple graders in order to provide data on inter-rater reliability.

Although the differences between the student cohorts are modest, our study shows that medical students retain key knowledge and skills relating to patient care when EBM is taught under the updated curricular model. Further inquiry is planned, but we are optimistic about the initial indications that a scaffolded, integrated approach to EBM instruction produces students who enter the clinical phase of their education ready to ask important questions, locate relevant information, appraise medical evidence, and apply their findings to patient care.

Stethoscope


Authors

Laura Menard, MLS
Indiana University School of Medicine

Female editor

Conflict of interest statement: The authors whose names appear on this manuscript certify that they have no affiliations or involvements with any organizations that have an interest, financial or non-financial, in any of the findings of this study.


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