Development, implementation, and outcomes of an initiative to integrate evidence-based medicine into an osteopathic curriculum

Abstract

Context: In response to the American Osteopathic Association's Commission on Osteopathic College Accreditation (COCA) standards set forth in 2008, osteopathic medical schools are restructuring curricula to demonstrate they are teaching the seven core competencies and integrating evidence-based medicine (EBM) throughout all 4 years of training.

Objective: To describe and evaluate the efforts of a college of osteopathic medicine to integrate EBM concepts into its curriculum while maintaining existing course content and faculty contact hours.

Design: One-group pre- and posttest study.

Setting: Kirksville College of Osteopathic Medicine-A.T. Still University (KCOM) in Missouri.

Participants: KCOM course directors in workshop series I (n=20) and KCOM faculty workshop series II (n=14).

Intervention: A faculty development workshop series based on the diffusion of innovations model was instituted to facilitate cultural change, gain faculty support, and accelerate the implementation of EBM throughout KCOM's curriculum.

Outcome measures: Faculty attitudes, confidence levels, and the number of courses that included instruction of EBM concepts were measured in August 2007 and May 2008.

Results: Faculty attitudes about integrating EBM into the curriculum and confidence levels measured pre- and postworkshop series found that 21 of 26 participants believed they improved their ability to locate primary EBM resources using the Internet; 21 of 28 improved their ability to teach EBM concepts to students. Fifteen of 16 faculty course directors agreed to find ways to incorporate EBM into their classes. Review of KCOM's course syllabi in April 2009 demonstrated a statistically significant difference (P<.001) in the number of faculty teaching EBM concepts after the faculty development workshop series concluded in March 2008 compared to before the series commenced in March 2006. An unexpected outcome was the implementation of a faculty-conceived, standalone EBM course in fall 2007.

Conclusions: A workshop series based on the diffusion of innovations model is effective in garnering faculty support for the implementation of a change in curriculum that emphasizes EBM content without increasing faculty contact hours or eliminating existing curricular content. A faculty development model emphasizing a "bottom-to-top" approach is effective in achieving workplace culture changes and seamless curricular transitions. Results have shown that a consensus building model is conducive to engaging faculty and garnering its support to effect curricular change, which, ultimately, ensures success.

Figure 1

Outline of diffusion of innovation (DOI) stages applied during the evidence-based medicine workshop series.

Figure 2

Bar graph displaying the number of courses at Kirksville College of Osteopathic Medicine that included evidence-based medicine concepts before the first faculty development workshop was conducted (Year 1) and after the development workshop series was completed, 3 years later (Year 3).

Figure 3

Bar graph displaying the number of faculty members at Kirksville College of Osteopathic Medicine who had integrated evidence-based medicine concepts into their courses before the first faculty development workshop was conducted (Year 1) and after the development workshop series was completed, 3 years later (Year 3).