BackgroundEvidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM.MethodsA mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively.ResultsA total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach.ConclusionsImplementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM.

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Objective: To investigate the source and risk factors associated with Australia's largest outbreak of Legionnaires’ disease. Design and setting: Epidemiological and environmental investigation of cases of Legionnaires’ disease associated with visits to the Melbourne Aquarium; two case–control studies to confirm the outbreak source and to investigate risk factors for infection, respectively. Participants: Patients with confirmed Legionnaires’ disease who visited the Melbourne Aquarium between 11 and 27 April 2000 were compared (i) with control participants from the community, and (ii) with control participants selected from other visitors to the Aquarium during this period. Main outcome measures: Risk factors for acquiring Legionnaires’ disease. Results: There were 125 confirmed cases of Legionnaires’ disease caused by Legionella pneumophila serogroup 1 associated with the Aquarium; 76% of patients were hospitalised, and four (3.2%) died. The Aquarium cooling towers were contaminated with this organism. Visiting the Aquarium was significantly associated with disease (odds ratio [OR], 207; 95% CI, 73–630). The case–control study indicated that current smoking was a dose‐dependent risk (multivariable OR for currently smoking > 70 cigarettes/week, 13.5; 95% CI, 5–36), but chronic illness and duration of exposure at the site were not significant risks. Conclusions: This study showed an association between poorly disinfected cooling towers at the Aquarium and Legionnaires’ disease in visitors, and confirmed current smoking as a critical risk factor. The rapid response, publicity, and widespread urinary antigen testing may have resulted in detection of milder cases and contributed to the relatively low apparent morbidity and mortality rates. The urinary antigen test allows rapid identification of cases and may be changing the severity of illness recognised as Legionnaires’ disease and altering who is considered at risk.

Notwithstanding some inaccuracies of coding and reporting, the morbidity and mortality for surgery of the large intestine remains high, largely due to the comorbidities of the patients, although certain technical complications such as leakage of an anastomosis after anterior resection are still associated with a significantly increased risk of death. Consideration should be given to the routine use of high-dependency nursing units for these high-risk patients after major colorectal surgery, and support from physicians to reduce morbidity and mortality from associated medical conditions worsened by surgery.