Context This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal “three circles” model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines. Methods The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline. Findings Common challenges across disciplines include (1) how “evidence” should be defined and comparatively weighted; (2) how and when the patient’s and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the “expert”; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise. Conclusions A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner’s expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed.

The heterogeneity of emotion skills curricular studies makes direct comparisons difficult. However, all controlled trials showed positive outcomes, suggesting the importance and effectiveness of 'other-directed' emotion skills training. No specific recommendations about curricular amount and frequency, timing and pedagogy can be made.

Introduction-Stress and burnout are endemic to post-graduate medical training but little research is available to guide supportive interventions. The identification of longitudinal emotional and developmental coping needs of internal medicine residents could assist in better designing and implementing supportive interventions.

Purpose Unhealthy behaviors contribute to half of U.S. deaths. However, physicians lack sufficient skill in counseling patients to change behaviors. Characterizing effective published curricular interventions for behavior-change counseling for medical trainees would inform educators toward improved training. Method The authors conducted a systematic literature search of studies published 1965–2011 evaluating curricula on behavior change counseling for medical trainees. Included studies described: (1) behavior change counseling, (2) teaching interventions for medical trainees, and (3) assessment of interventions. The authors extracted eligible articles, rated outcomes for learners and patients using Kirkpatrick’s hierarchy, and determined study quality. Results Of 2,788 identified citations, 109 met inclusion criteria. Most studies were performed in the United States (98), 93 at a single institution, and 81 in primary care settings. Curricular topics for counseling included smoking (67 studies), nutrition (30), alcohol/drug use (26), and exercise (22). Although most studies did not include theoretical frameworks, 39 used the Transtheoretical Model of Change. Sixty-two studies involved eight or fewer hours of curricular time, and 51 spanned four or fewer weeks. The studies with highest-level outcomes and quality employed multiple curricular techniques and included practice of counseling techniques in either simulated or actual clinical settings. Conclusions Existing literature suggests that trainees learn behavior change counseling through active, realistic practice and implementation of reminder and feedback systems within actual clinical practice settings. Multi-institutional medical education research on methods of teaching behavior-change counseling that influence patients’ health outcomes are needed to ensure trainees’ clinical competence and improve patient care.