Description and Evaluation of an Evidence-Based Residency Curriculum Using the Evidence-Based Medicine Environment Survey.

BACKGROUND AND OBJECTIVES: Teaching medical trainees evidence-based medicine (EBM) is required by the Accreditation Council for Graduate Medical Education. Most published graduate EBM curricula focus on critical appraisal over point-of-care information mastery. Faculty at the University of Rochester Family Medicine Residency implemented a clinically integrated, cyclical EBM curriculum juxtaposing information mastery with expert-level skills such as critical appraisal. We administered the Evidence-Based Medicine Environment Survey (EBMES) to learners before and after the yearlong curriculum. METHODS: Two cohorts of participating third-year residents completed the EBMES before and after an EBM curriculum. RESULTS: Over 2 years, 21 residents completed pre- and postevaluations. Resident perception of the EBM educational and practice environment was high at baseline and improved for 15 of 36 survey items (P<.05). CONCLUSIONS: Resident perception of the EBM learning environment improved after participation in a yearlong curriculum. Nearly all of the content covered in the "Science of Family Medicine" curriculum and measured by EBMES improved in a statistically significant manner. We propose that EBM curricula should combine traditional literature search and critical appraisal skills with information mastery to maximize effectiveness. Our curriculum can be modified to fit other graduate family medicine contexts.

The Medical Education Pathway: description and early outcomes of a student-as-teacher program.

PROBLEM: Although senior medical students at the University of Rochester School of Medicine and Dentistry (URSMD) have a long history of teaching junior peers, no formal educational training existed for students until 2007. The Medical Education Pathway (MEP) at the URSMD is a longitudinal student-as-teacher program that addresses both the local precedent of medical student teaching and the ongoing need to prepare students for teaching in residency and beyond. APPROACH: In 2007, administrative faculty spearheaded efforts to create the MEP Committee, whose members then designed and implemented an elective curriculum. The curriculum balances didactics and experiential learning. A rigorous two-step application process precedes acceptance into the MEP. Participating students receive mentoring, assessment, and formative feedback on lecture delivery and leadership of various small-group formats. OUTCOMES: Since 2007, 89 students have enrolled in the MEP: 49 have successfully completed it, and 40 are currently enrolled. MEP students teach in basic science and clinical courses, and they regularly make novel contributions to the medical school curriculum. Student learner peers demonstrate an ability to give constructive feedback to MEP students. Exit survey comments demonstrate that the MEP influences participating students' career plans. Lessons learned from implementing the MEP include the importance of institutional support, dedicated faculty who value student teaching, and flexibility in scheduling. NEXT STEPS: Future improvements to the MEP include enhancing the assessment process and tracking the careers of graduates as outcome data. The MEP serves as a model for a successful student-as-teacher program in other institutions and settings.