Background: Evidence-Based and Informed Clinical Practice is identified by the ACGME as a core clinical milestone (PBLI1). The Evidence Based Medicine (EBM) curriculum in the University of Wisconsin (UW) Internal Medicine Residency Program previously focused on didactics, journal clubs, and independent study. The COVID-19 pandemic interrupted these traditional EBM teaching methods, prompting us to re-evaluate and subsequently develop a new, interactive, resident-led curriculum.
Purpose: The pre-pandemic EBM curriculum consisted of a bimonthly resident-led journal club, a weekly resident-led grand rounds-style presentation, and a series of faculty-led EBM lectures. A 2018 exit survey of residents showed that nearly all residents agreed or strongly agreed that our curriculum was well-organized and improved their critical reading skills. However, only 12.5% of graduating residents felt comfortable developing clinical questions, searching the literature, and critically appraising study results. In 2020, our in-person curriculum was suspended due to the COVID-19 pandemic. This allowed us to explore and develop alternative methods of teaching EBM with the goal of improving resident comfort with primary literature searches, critical appraisal of articles, and competence in the ACGME PBLI1 milestone.
Description: Two resident-led activities were developed to fill gaps identified in the previous EBM curriculum. Faculty-led EBM lectures were replaced by seven asynchronous online modules to ensure each learner received a comprehensive overview of EBM concepts. Each module consisted of a series of 5-10 minute videos created by residents or faculty and edited by a chief resident and faculty leader. PGY2 residents complete the modules during a dedicated outpatient rotation, but all residents have continuous access to these resources for the duration of residency. Prior to and following module completion, residents complete the Fresno test, a validated tool to assess knowledge of EBM principles. The second activity, the “Evidence Based Clinical Practice Exercise” (EBCP), has the resident identify a clinical question and then work through the EBM process to address the question while on primary care block. The resident presents findings to the clinic attending and a summary is sent to the entire residency in a biweekly email known as “EBM Corner”. Clinical faculty provide verbal and written feedback on the resident’s EBCP exercise and critical appraisal skills. We have continued our resident-led journal clubs and grand rounds-style presentations.
Conclusions: The COVID-19 pandemic spurred an evolution of our residency EBM curriculum that now includes asynchronous modules and a new exercise that allows residents to demonstrate EBM skills and disseminate summaries of clinically relevant evidence. Formalized assessment and survey data to assess the effectiveness of these curricular changes is ongoing and will be available later this academic year.