Practising evidence-based medicine (EBM): a descriptive analysis of medical students’ whole-task EBM assignments

Abstract

Researchers have suggested whole-task learning activities to practice and teach evidence-based medicine (EBM); however, limited description exists of their use in EBM curricula. This article describes medical students' execution of a whole-task EBM assignment and characterises themes emerging from assignment submissions. Between 2013 and 2015, Stanford University's paediatric clerkship students completed a whole-task EBM assignment based on a patient encounter. The assignment captured students' efforts to perform all EBM steps and describe their patient scenario and future knowledge needs strategies. Assignments were analysed using descriptive statistics and qualitative description. 123 students completed the assignment. Students formulated therapy (n=76), prognosis (n=18), diagnosis (n=15), harm (n=9) and aetiology (n=2) questions, and used a single (n=58) or multiple information resources (n=57). Based on evidence appraisal, 95 students indicated that the found evidence would inform future practice while 16 were sceptical of its conclusivity. 65 learners wanted to share evidence with colleagues; 33 with patients and families. To meet future knowledge needs, learners suggested using a structured approach (eg, PICO (patient, intervention, comparison and outcome); n=58), reading more primary literature (n=22) and creating question logs (n=21). This article provides a glimpse into students' EBM process and demonstrates the feasibility of whole-task activities for use in EBM training. Findings related to students' clinical uncertainty and information sharing raise questions about coverage of these topics in current EBM training and suggest that further investigation is warranted.

Integrating Wikipedia editing into health professions education: a curricular inventory and review of the literature

“…Our findings indicate that Wikipedia editing courses introduce students to EBM skills and provide opportunities to apply these skills. Currently many learners initially encounter EBM in preclinical training [52,53], which can make it difficult to appreciate its relevance to their future clinician roles [13,54]. For example, critical appraisal, the process of systematically judging research for trustworthiness and relevance to a particular context [55], is often taught using tra-ditional approaches, such as journal clubs, that can seem disconnected from patient care.…”

Integrating Wikipedia editing into health professions education: A curricular inventory and review of the literature

“…Currently many learners initially encounter EBM in preclinical training [52,53], which can make it difficult to appreciate its relevance to their future clinician roles [13,54]. In contrast, the authentic experience of editing pages to be viewed by potentially thousands of readers is an intrinsically motivating approach to EBM [13,55]. However, a minority of courses explicitly referenced EBM, while the vast majority taught one or more EBM skills, speaking to a missed opportunity to make a direct link.…”

Understanding medical student evidence-based medicine information seeking in an authentic clinical simulation

“…Recent studies of medical students' information seeking focus on what resources they report using, what barriers to practicing EBM they perceive, and what technologies they use to perform this work [6][7][8][9]. Time management and lack of technical expertise are two of the most common challenges that medical students face when they seek research evidence to support their clinical decisions in the clinical context [6].…”