Teaching Evidence Based Medicine Early in Training

Background: Evidence-Based Medicine (EBM) improves physicians’ clinical decision-making through refining the skills of asking a clinical question, searching for and appraising the literature and then properly applying it to patient care. While EBM has been implemented as an essential module across medical schools worldwide, most graduates are not well versed in the fundamentals of effectively and critically appraising the literature. To address this concern, we pioneered a curriculum for incoming medical trainees focused on improving their basic EBM skills.

Methods: Incoming first year residents are enrolled in an EBM course during the first three months of internship as part of a comprehensive one-month rotation. The course is based on a formal curriculum consisting of six 2-hour small-group interactive sessions that emphasize the core concepts of EBM. During each session, trainees will learn basic EBM concepts in small groups and be facilitated to apply their skills on a designated article (table 1). In order to measure their acquired skills, residents are required to complete a validated pre- and post- course Berlin questionnaire. Participants are also asked to complete a written evaluation upon completion of the course, reflecting on their experience.

Results: A total of 76 interns attended the course over the past 2 years. All participants completed the pre- and post- course assessments. The mean score on the pre-course test was 55.9% compared to 73% on the post-course test; a mean increase of 17.1% (p-value <0.0001).  The majority of residents (79%) improved on post-course assessment, compared to 9% who performed worse and 12% who maintained the same score. While only 32% of the residents were able to answer more than two-thirds of questions correctly on the pre-course test, 80% of residents were able to do so upon completion of the course. Participants had a satisfactory educational experience as evident in their evaluation. About 88% of participants rated the course as very good to excellent in categories assessing its organization, clarity and overall value or utility. The written feedback received was equally encouraging.

Conclusions: Delivering basic principles of EBM in an interactive small-group learning environment ripens the skills of residents. While this educational intervention shows a favorable outcome on learning and a meaningful increase in EBM knowledge, further study is needed to evaluate its impact on resident’s clinical practice and the effect on patients’ outcomes.