Clinical Physician Assistant Students' Perceptions of Evidence-Based Medicine Resources: A Cross-Sectional Examination.

Evidence-based medicine (EBM) instruction is required for physician assistant (PA) students. As a follow-up to an initial didactic year survey, this study seeks to understand which attributes of EBM resources clinical PA students find most and least useful, their self-efficacy utilizing medical literature, and their usage of EBM tools in the clinic. Results indicate that students preferred UpToDate and PubMed. PA students valued ease of use, which can inform instructors and librarians. Respondents utilized EBM tools daily or a few days a week, underscoring the importance of EBM tools in real-world scenarios. After their clinical year, students felt moderately confident utilizing the medical literature, emphasizing EBM training.

[Interpreting the evidence. Reducing subjectivity in appraising the evidence calls for a return to teaching evidence-based medicine.] / L'interpretazione delle evidenze. Per ridurre la soggettività nella lettura delle prove serve tornare a insegnare l'evidence-based medicine.

The interpretation of clinical research evidence is still characterized by wide subjectivity. This subjectivity is also visible when comparing guidelines and recommendations developed by institutions and learned societies. It is often due to bias and conflicts of interest experienced by the members of guideline panels: thus, the role of editors and publishers of journals and scientific media becomes increasingly important, and they should return to careful oversight of the content of what is published. To address the problem, however, it is necessary to return to teaching evidence-based medicine in order to restore its function as a "North star" in clinical practice and public health decision-making.

Integrating training in evidence-based medicine and shared decision-making: a qualitative study of junior doctors and consultants.

BACKGROUND: In the past, evidence-based medicine (EBM) and shared decision-making (SDM) have been taught separately in health sciences and medical education. However, recognition is increasing of the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centered decision-making using SDM. However, there are few empirical investigations into the benefits of training that integrates EBM and SDM (EBM-SDM) for junior doctors, and their influencing factors. This study aimed to explore how integrated EBM-SDM training can influence junior doctors' attitudes to and practice of EBM and SDM; to identify the barriers and facilitators associated with junior doctors' EBM-SDM learning and practice; and to examine how supervising consultants' attitudes and authority impact on junior doctors' opportunities for EBM-SDM learning and practice. METHODS: We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting with protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course semi-structured interviews with 12 junior doctors and thematically analysed the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated learning and practice of EBM and SDM. Based on the responses of junior doctors, we then conducted interviews with ten of their supervising consultants and used a second thematic analysis to understand the influence of consultants on junior doctors' EBM-SDM learning and practice. RESULTS: Junior doctors appreciated EBM-SDM training that involved patient participation. After the training course, they intended to improve their skills in person-centered decision-making including SDM. However, junior doctors identified medical hierarchy, time factors, and lack of prior training as barriers to the learning and practice of EBM-SDM, whilst the private healthcare setting with protected learning time and supportive consultants were considered facilitators. Consultants had mixed attitudes towards EBM and SDM and varied perceptions of the role of junior doctors in either practice, both of which influenced the practice of junior doctors. CONCLUSIONS: These findings suggested that future medical education and research should include training that integrates EBM and SDM that acknowledges the complex environment in which this training must be put into practice, and considers strategies to overcome barriers to the implementation of EBM-SDM learning in practice.

Knowledge, Attitude, and Practice (KAP) Status toward Clinical Reasoning and Evidence-Based Medicine among the Medical Interns and Gynecology Residents of Iran University of Medical Sciences.

Background: Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. Objective: We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. Methods: A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. Results: A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P < 0.05). Research experience was associated with better CR-K and all KAP components for EBM (P < 0.05). Conclusion: The total score and many of the KAP components had moderate status for clinical reasoning and EBM. Planning on the associated factors should be regarded in the future. Such questionnaires are suggested to be validated for use in quasi-experimental studies.

Interpretation and use of a decision support tool for multiple treatment options: a combined randomised controlled trial and survey of medical students.

OBJECTIVES: To investigate medical students' ability to interpret evidence, as well as their self-assessed understandability, perceived usefulness and preferences for design alternatives in an interactive decision support tool, displaying GRADE evidence summaries for multiple treatment options (Making Alternative Treatment CHoices Intuitive and Trustworthy, MATCH-IT). DESIGN: A combined randomised controlled trial and survey. Participants were presented with a clinical scenario and randomised to one of two versions of the MATCH-IT tool (A/B), instructed to explore the evidence and decide on a recommendation. Participants answered a questionnaire assessing interpretation, treatment recommendation self-assessed understandability and perceived usefulness before exposure to the other MATCH-IT version and asked questions on design preferences. SETTING: Online lecture in an evidence-based medicine (EBM) introductory course. PARTICIPANTS: 149 third-year medical students. 52% (n=77) had 6 months of clinical training and 48% (n=72) had preclinical training only. INTERVENTIONS: The MATCH-IT tool version A uses colour coding to categorise interventions by magnitude and direction of effects and displays all outcomes in a table on entry. Version B has no colour coding, and the user must decide which outcomes to display in the table. MAIN OUTCOME MEASURES: Interpretation of evidence, treatment recommendation, perceived usefulness and understandability, preference for format and design alternatives. RESULTS: 82.5% (n=123) of medical students correctly answered ≥4 out of 5 multiple choice questions assessing interpretation of data. 75.8% (n=114) of students made a treatment recommendation in accordance with an expert panel for the same clinical scenario. 87.2% (n=130) found the tool understandable while 91.9% perceived the tool as useful in addressing the clinical scenario. CONCLUSION: Medical students with no prior training in EBM can interpret and use the MATCH-IT tool. Certain design alternatives were preferred but had no bearing on interpretation of evidence or understandability of the tool.

Implementation of an Evidence-Based Medicine Curriculum for Postgraduate Emergency Medicine Physician Assistant and Nurse Practitioner Fellows.

INTRODUCTION: Within physician assistant (PA) education, the inclusion of evidence-based medicine (EBM) is mandatory. Despite existing literature on EBM training methodologies for PA students and emergency medicine (EM) physician residents, there exists a dearth of published data concerning EBM instruction within postgraduate PA EM programs. A pilot study is described providing an overview of implementation of an EBM curriculum in a single-institution postgraduate physician assistant and nurse practitioner emergency medicine fellowship. METHODS: Quantitative data using pre-curriculum and post-curriculum surveys were collected. The curriculum included statistical concept screencasts, required attendance at a journal club with assigned topics for discussion, and used a critical appraisal tool designed to help fellows better analyze and understand the articles being reviewed. Upon graduation, fellows participated in structured interviews to collect qualitative data about the curriculum and application of learned concepts to the clinical setting. RESULTS: There was a statistically significant improvement in fellows' reported confidence in discussing the medical literature with practicing providers ( P = .02). However, there was no difference in prescores and postscores on EBM knowledge questions or on fellows' feelings of importance of EBM to clinical practice. Qualitative data revealed several themes, including helpfulness of tools provided in the curriculum, appreciation of curricular changes made secondary to fellow suggestions, and reports of improvement in reviewing medical literature and comfort in participation in local journal clubs upon graduation from the fellowship program. DISCUSSION: Limitations, including small sample size and validity concerns, are discussed. Positive changes were made to the curriculum based on qualitative data collected. The authors advocate for subsequent investigations into this subject within a multi-institutional and multispecialty context, thereby enhancing the breadth of the findings. Nevertheless, this study furnishes the initial accessible substantiation of the viability of introducing an EBM curriculum within this specific demographic.

Artificial intelligence education: An evidence-based medicine approach for consumers, translators, and developers.

Current and future healthcare professionals are generally not trained to cope with the proliferation of artificial intelligence (AI) technology in healthcare. To design a curriculum that caters to variable baseline knowledge and skills, clinicians may be conceptualized as "consumers", "translators", or "developers". The changes required of medical education because of AI innovation are linked to those brought about by evidence-based medicine (EBM). We outline a core curriculum for AI education of future consumers, translators, and developers, emphasizing the links between AI and EBM, with suggestions for how teaching may be integrated into existing curricula. We consider the key barriers to implementation of AI in the medical curriculum: time, resources, variable interest, and knowledge retention. By improving AI literacy rates and fostering a translator- and developer-enriched workforce, innovation may be accelerated for the benefit of patients and practitioners.

Use of simulation scenarios and vote cards in teaching critical appraisal concepts in evidence-based medicine.

BACKGROUND: The most effective method of teaching critical appraisal concepts remains unclear. We used simulation scenarios in a Risk-of-Bias (RoB) 2.0 framework to teach the various biases that may affect randomized controlled trials and assessed whether including this interactive session in an evidence-based medicine (EBM) course for third-year preclinical medical students can optimize their understanding of critical appraisal concepts. METHODS: The session had 13 modules, each corresponding to a particular risk of bias in RoB 2.0. Each module included a simulated scenario, followed by data presentation and a generalized conclusion. The students were subsequently asked to use colored vote cards to indicate whether they agreed, had some concern, or disagreed with the conclusion and to justify their answers. On the basis of the students' answers, the facilitator debriefed the scenario and addressed the specific bias. In each module, the students were required to demonstrate critical thinking in analyzing the claims and quality of the supporting evidence and in justifying their decisions, thus conceptualizing their understanding of research biases. RESULTS: We included 306 students across two pilot sessions in spring 2020 and 2021, and the response rate was 97.4%. The students were least able to discern the following problems: baseline imbalances when assessing allocation bias (correct answers: 9.06%), missing outcome data when assessing attrition bias (correct answers: 11.65%), and balanced nonprotocol interventions when assessing performance bias (correct answers: 14.88%). The postcourse survey revealed several aspects of the interactive session that the students appreciated or found challenging. CONCLUSION: Preclinical medical students generally appreciated the inclusion of simulation scenarios and vote cards in an EBM course. The use of vote cards facilitated medical students' understanding of critical appraisal concepts, uncovered areas that they found challenging to understand, and encouraged their active participation. Such interactive sessions should be increasingly included in medical education.

Integrating evidence-based medicine into resident education.

Evidence-based medicine (EBM) is the practice of applying scientific evidence to clinical decision-making, with a focus on addressing the individualized needs and values of patients. It requires not only a solid foundation of medical knowledge and the ability to gather a thorough patient history but also the skills to locate, interpret, and apply relevant principles from the medical literature. Given the rapid advancements in the field of medicine, understanding medical literature holds significant importance for residents during their education and future careers. It is particularly crucial for reducing medical waste, adhering to guidelines, and decreasing morbidity and mortality rates. This paper aims to underscore the significance of increasing residents' exposure to evidence-based approaches in clinical decision-making, propose time-efficient and effective methods to enhance their understanding of EBM, and promote the implementation of evidence-based practices within the inpatient setting.

Evidence-Based Medicine and Pharmacotherapy Content Alignment.

OBJECTIVE: When effectively executed, content alignment can aid student performance in associated courses. Limited research exists for content alignment of evidence-based medicine (EBM) and pharmacotherapy courses. This study assesses the impact of EBM and pharmacotherapy course alignment on student performance. METHODS: Content alignment included assignment of 6 landmark trials in EBM coursework. The articles were identified by pharmacotherapy instructors as "landmark" to management of associated diseases in the aligned pharmacotherapy semester. Articles were the basis for quizzes over skills taught in the EBM course and were referenced during pharmacotherapy lectures. RESULTS: During the alignment semester, students were more likely to cite specific guidelines and/or primary literature to rationalize pharmacotherapeutic plans on examinations compared with the prealignment period (54% vs 34%). Overall, pharmacotherapy case performance and plan rationale scores were significantly higher in the alignment semester compared with prealignment. Student performance on the Assessing Competency in Evidence-Based Medicine tool improved from the start of the semester (8.64, SD 1.66) to the end (9.5, SD 1.49; mean score +0.86). Comfort in applying EBM analysis to primary literature increased significantly between the first and final assignments, with 6.7% and 71.7% of students self-reporting a high degree of confidence, respectively. Students (73%) reported an enhanced understanding of pharmacotherapy due to alignment compared with a previous semester of pharmacotherapy without alignment. CONCLUSION: The use of landmark trial assignments to align EBM and pharmacotherapy coursework demonstrated a positive impact on student rationale for clinical decision-making and student confidence in evaluating primary literature.

Challenges of the Presence and Absence of Clinical Librarians in the Use of Evidence-Based Medicine in Clinical Departments.

Due to the rapid growth of information technology and medical information resources, medical personnel need to search and retrieve valid and updated information. However, with limited time to access these resources, there is a need for clinical librarians to connect medical staff to evidence-based medicine (EBM). The present study was conducted to identify the challenges in the absence and the benefits of the presence of clinical librarians in the application of EBM in clinical departments. Ten clinical physicians working at Children's Medical Center Hospital in Tehran, Iran were interviewed for this qualitative study. Most of the hospital-based physicians did not make any systematic use of EBM and seven were not familiar with the term "clinical librarian." In their opinion, the clinical librarians' activities included training the clinical and research teams, providing them with the required information, and providing an EBM-oriented approach to morning report and educational rounds. Therefore, the services delivered by clinical librarians in various hospital departments might positively influence the hospital-based physicians' information-seeking behavior.

Evidence-based medicine needs patient and public involvement to remain relevant: A proposal for a new curriculum / La medicina basada en la evidencia requiere la participación de la ciudadanía para mantener su relevancia: Propuesta para un nuevo plan de estudios

Introduction Public partnerships, a route to sharing expertise, networks and resources anchored in the United Nations Sustainable Development Goals, has been championed by multiple stakeholders. Objective To propose a new evidence-based medicine (EBM) curriculum for harnessing patient and public expertise to ensure that EBM teaching and learning can become more relevant and impactful. Methods A curriculum development group comprising of EBM teachers, patient and public involvement representatives, clinicians, clinical epidemiologists, public health experts and educationalists, with experience of delivering and evaluating face-to-face and online EBM courses across many countries and continents, prepared a new EBM course. Results A student-centred, problem-based and clinically integrated course for teaching and learning EBM was developed. In the spirit of shared decision-making, practitioners can learn to support patients, articulate their perspectives, recognise the need for their contribution and ensure community involvement when generating and applying evidence. With end users in mind, the application of research findings, delivery of care and EBM effectiveness in the workplace would carry increased priority. Conclusion Embracing patients as EBM collaborators can help deliver cognitive diversity and inspire different ways of thinking and working. Adopting the proposed approach in EBM education lays the foundations for a joint practitioner–patient partnership to ask, acquire, appraise and apply EBM in a more holistic context which will strengthen the EBM proposition (AU)

Introducción Las asociaciones de pacientes y ciudadanos constituyen una vía para compartir experiencias, redes y recursos siendo promovidas por los objetivos de desarrollo sostenible de la Organización de Naciones Unidas (ONU), y defendidas por todas las partes y sectores interesados. Objetivo Proponer un nuevo plan de estudios de medicina basada en la evidencia (MBE) para aprovechar la experiencia de los pacientes con el fin de garantizar de que la enseñanza y el aprendizaje de la MBE sean más relevantes e impactantes. Métodos Un grupo de expertos compuesto por profesores del área de MBE, representantes de pacientes, médicos, epidemiólogos clínicos, expertos en salud pública y pedagogos, con experiencia en la impartición y evaluación de cursos de MBE presenciales y online en el ámbito internacional, desarrolló e implementó un curso de MBE. Resultados Se desarrolló un curso centrado en el estudiante, basado en problemas y clínicamente integrado para la enseñanza y el aprendizaje de la MBE. En el espíritu de la toma de decisiones compartida, los profesionales pueden aprender a apoyar a los pacientes, a articular sus perspectivas, a reconocer la necesidad de su contribución y a garantizar la participación de la comunidad a la hora de generar y aplicar las pruebas. La aplicación de los resultados de la investigación, la prestación de cuidados y la eficacia de la MBE en el lugar de trabajo son las áreas de mayor prioridad para los asistentes. Conclusiones Adoptar a los pacientes como colaboradores de la MBE puede ayudar a proporcionar diversidad cognitiva e inspirar diferentes formas de pensar y trabajar. La adopción del enfoque propuesto en la formación en MBE sienta las bases para una colaboración conjunta entre profesionales y pacientes para preguntar, adquirir, valorar y aplicar la MBE en un contexto más holístico que reforzará la propuesta de MBE (AU)

Effectiveness of clinical integrated short course training of evidence based medicine for postgraduate medical specialty students in Ethiopia in 2022: A randomized control trial.

BACKGROUND: Evidence based medicine (EBM) is a newly emerged philosophy of medical education and health care service which brings quality of health service, efficient use of materials, and patient satisfaction. OBJECTIVE: To investigate the effectiveness of clinical integrated short course training of EBM for post-graduation medical specialty students in Ethiopia, 2022. METHOD: Randomized, single blind, superiority trial, and multi-centric experimental study design employed. The eligible candidates randomly assigned to the interventional group and the control group (waitlisted). The allocation of the participant concealed from the principal investigator and participant. Sample size was determined with a two-sided test and α level of 5% and 80% power with the total of 52 calculated sample size and 44 (21 for intervention and 23 for control group) students were used for final analysis. Mann Whitney U test and Independent Sample T test used to test mean difference between intervention and control group after checking normality distributions to estimates the amount by which the training changes the outcome on average compared with the control. The result of the final model expressed in terms of adjusted mean difference and 95% CI; statistical significance declared if the P-value is less than 0.05. RESULTS: Among 44 postgraduate students, only 29.5% practices EBM during delivering of clinical services. Overall EBM knowledge was changed with adjusted mean difference (Mean±SD 17.55 (13.9, 21.3), p<000). This training provided significant change in all main domain of EBM, more in validity evaluation of the study (Mean±SD, 3.8(1.3, 6.2), p<0.0018) and impact of study design (Mean±SD, 3.8(2.6, 5.1), p<0.000). There was also significant change of overall attitude with adjusted mean difference (Mean±SD, -8.2(-9.6,-6.7), p = 000). CONCLUSION: Clinical integrated EBM training brought significant change of knowledge and skills of principles and foundations of EBM. Adopting principles of EBM into curricula of postgraduate specialty students would assure the quality of medical care and educations.

[Complementary and Alternative Medicine Offers of Teaching Practices for General Medicine]. / Komplementär- und alternativmedizinische Angebote von Lehrpraxen für Allgemeinmedizin.

OBJECTIVE: Germany's new medical licensure act has increased the importance of general practice in academic medical education. This study gives an overview of complementary and alternative medicine in general teaching practices in Germany and their adherence to evidence-based criteria which is required in order to qualify as a teaching practice. METHODS: After a systematic search for German teaching practices, we assessed their diagnostic and therapeutic offers via their websites. We calculated the various frequencies of treatments and differentiated between evidence-based complementary medicine and alternative medicine with little to no evidence. RESULTS: Of 4102 practices, more than half offered complementary and/or alternative treatment. Most of those were treatments approved of by the German medical association. Alternative medicine was offered by 18.2% of the practices. CONCLUSION: Collective terms and conflicting evidence complicate the classification of treatments. Teaching practices offering non-evidence-based treatment raise the question whether recruitment of additional teaching practices stands at odds with the quality of medical education. Explicit offers of alternative treatment should disqualify a teaching practice as such. Controversial treatment may be taught academically and during residency with a focus on evidence-based guidelines and communication skills in order to prepare young medical practitioners for talks with their patients about the subject.

Enculturating a Community of Action: Health Professions Educators' Perspectives on Teaching With Wikipedia.

PURPOSE: Health professions educators are increasingly called on to engage learners in more meaningful instruction. Many have used Wikipedia to offer an applied approach to engage learners, particularly learning related to evidence-based medicine (EBM). However, little is known about the benefits and challenges of using Wikipedia as a pedagogic tool from the collective experience of educators who have sought to improve their instructional practice with it. This study aims to synthesize the perspectives of health professions education (HPE) instructors on the incorporation of Wikipedia editing into their HPE courses. METHOD: Applying a constructivist approach, the authors conducted semistructured interviews from July to December 2020, with 17 participating HPE instructors who had substantively integrated Wikipedia into their curriculum at 13 institutions. Participants were interviewed about their experiences of integrating Wikipedia editing into their courses. Thematic analysis was conducted on resulting transcripts. RESULTS: The authors observed 2 broad themes among participants' expressed benefits of teaching with Wikipedia. First, Wikipedia provides a meaningful instructional alternative that also helps society and develops learners' information literacy and EBM skills. Second, Wikipedia supports learners' careers and professional identity formation. Identified challenges included high effort and time, restrictive Wikipedia sourcing guidelines, and difficult interactions with stakeholders. CONCLUSIONS: Findings build on known benefits, such as providing a real-world collaborative project that contextualizes students' learning experiences. They also echo known challenges, such as the resource-intensive nature of teaching with Wikipedia. The findings of this study reveal the potential of Wikipedia to enculturate HPE students within a situated learning context. They also present implications for HPE programs that are considering implementing Wikipedia and faculty development needed to help instructors harness crowd-sourced information tools' pedagogic opportunities as well as anticipate their challenges.

Validity and reliability of the Spanish version of the ACE tool for assessing competencies in evidence-based medicine in medical students.

OBJECTIVE: To translate and culturally adapt the tool 'Assessing Competency in evidence-based medicine (EBM)' (ACE) to Spanish and to implement it in a cohort of medical students for the evaluation of the instrument's psychometric properties. DESIGN: Bilingual translators produced a translation and backtranslation of the original instrument, with interim consensus in each stage with oversight and input by a group of experts. We then performed cognitive interviews to adapt the wording of the tool culturally. Finally, we implemented the final version in a cohort of medical students on a virtual general practice course with EBM modules. SETTING: Medical School in Buenos Aires, Argentina. Due to restrictions to in-person teaching during the COVID-19 pandemic, we conducted this study in the context of virtual learning. PARTICIPANTS: We included 125 fourth and fifth-year medical students. MAIN OUTCOME MEASURES: We measured internal consistency with the Kuder-Richardson coefficient (>0.6 as a threshold for reliability) and construct validity through a Pearson's correlation between the examinations carried out with the translated instrument and the results of the regular examinations of EBM in the same students (expected values of at least 0.3 to 0.7). We also compared the total score of the instrument of fifth-year students to fourth-year students. RESULTS: As for measurements for internal consistency, the coefficient Kuder-Richardson resulted in a value of 0.268, below our prespecified threshold. For construct validity, the Pearson correlation between the sum of the items and regular examinations was 0.139, also below our prespecified threshold. However, fifth-year students averaged 0.94 points more than fourth-year students (95% CI 0.24 more to 1.65 more). CONCLUSION: The translated and cross-culturally adapted version of the ACE tool into Spanish had low reliability and validity in an MBE course taught and evaluated in a virtual environment. TRIAL REGISTRATION: Not applicable.

Didactic Physician Assistant Students' Perceptions of Evidence-Based Medicine Resources: A Preliminary Investigation.

Evidence-Based Medicine (EBM) instruction is required for physician Assistant (PA) students. This pilot study surveyed didactic PA students at three geographically diverse PA programs at the end of their didactic EBM course to understand which attributes of EBM resources they find most and least useful, and their self-efficacy in searching and appraising medical literature. Thematic analysis identified the most important student-reported attributes of a resource. PA students in this sample preferred UpToDate and PubMed as their top EBM tools based on attribute ratings. However, each database included in this pilot study received positive feedback, despite a low usage rate across institutions. The most important attributes were ease of use/search, information presentation, and conclusion/critical appraisal skill. After one EBM course, on average, students rated their self-efficacy searching the literature and appraising the literature as "moderately confident." This suggests that instructors and librarians have an opportunity to expose students to more tools as well as encourage "the right tool for the right job."