A clinically integrated curriculum in evidence-based medicine for just-in-time learning through on-the-job training: the EU-EBM project

Abstract

Background: Over the last years key stake holders in the healthcare sector have increasingly recognised evidence based medicine (EBM) as a means to improving the quality of healthcare. However, there is considerable uncertainty about the best way to disseminate basic knowledge of EBM. As a result, huge variation in EBM educational provision, setting, duration, intensity, content, and teaching methodology exists across Europe and worldwide. Most courses for health care professionals are delivered outside the work context ('stand alone') and lack adaptation to the specific needs for EBM at the learners' workplace. Courses with modern 'adaptive' EBM teaching that employ principles of effective continuing education might fill that gap. We aimed to develop a course for post-graduate education which is clinically integrated and allows maximum flexibility for teachers and learners.

Methods: A group of experienced EBM teachers, clinical epidemiologists, clinicians and educationalists from institutions from eight European countries participated. We used an established methodology of curriculum development to design a clinically integrated EBM course with substantial components of e-learning. An independent European steering committee provided input into the process.

Results: We defined explicit learning objectives about knowledge, skills, attitudes and behaviour for the five steps of EBM. A handbook guides facilitator and learner through five modules with clinical and e-learning components. Focussed activities and targeted assignments round off the learning process, after which each module is formally assessed.

Conclusion: The course is learner-centred, problem-based, integrated with activities in the workplace and flexible. When successfully implemented, the course is designed to provide just-in-time learning through on-the-job-training, with the potential for teaching and learning to directly impact on practice.

Figure 1

An overview of teaching and learning activities in the EU EBM course. Graphical representation of the EU-EBM curriculum. A facilitator picks up problems encountered with patients in daily clinical work and helps in formulating targeted questions. Hereafter, the learner attends the e-learning modules and consequently completes small activities and an assignment. All five modules are collected in a portfolio. After successful completion of the course, the student will receive a course certificate.

Figure 2

Screenshot from one of the EU-EBM e-learning modules. Screenshot showing the various audiovisual teaching modalities that are applied in the e-learning session to support self-directed learning: a) a person is talking to the learner; b) the learner can follow the presentation by reading the notes; c) the slide summarizes the core content of the presentation; it may contain hyperlinks to other topics in the same module; d) the sidebar provides orientation to the learner about the content of the lecture; e) the bottom bar allows the learner to pause, or quickly navigate forth and back.

Figure 3

An overview of educational strategy of the EU-EBM curriculum according to the SPICES model. The educational strategy of the EU-EBM curriculum according to the SPICES model [19] moving away from traditionally, teacher centred educational programs to student orientated, problem based learning programs. The size of the arrows in this figure indicates the magnitude of change between a traditional and the EU-EBM course.