Methods of teaching medical trainees evidence-based medicine: a systematic review

Abstract

Context: The principles of evidence-based medicine (EBM) provide clinicians with the ability to identify, source, appraise and integrate research evidence into medical decision making. Despite the mantra of EBM encouraging the use of evidence to inform practice, there appears little evidence available on how best to teach EBM to medical trainees. A systematic review was performed to identify what type of educational method is most effective at increasing medical trainees' competency in EBM.

Methods: A systematic review of randomised controlled trials (RCTs) was performed. Electronic searches were performed across three databases. Two reviewers independently searched, extracted and reviewed the articles. The quality of each study was assessed using the Cochrane Collaboration's risk of bias assessment tool.

Results: In total, 177 citations were returned, from which 14 studies were RCTs and examined for full text. Nine of the studies met the inclusion criteria and were included in this review. Learner competency in EBM increased post-intervention across all studies. However, no difference in learner outcomes was identified across a variety of educational modes, including lecture versus online, direct versus self-directed, multidisciplinary versus discipline-specific groups, lecture versus active small group facilitated learning.

Conclusions: The body of evidence available to guide educators on how to teach EBM to medical trainees is small, albeit of a good quality. The major limitation in assessing risk of bias was the inability to blind participants to an educational intervention and lack of clarity regarding certain aspects within studies. Further evidence, and transparency in design, is required to guide the development and implementation of educational strategies in EBM, including modes of teaching and the timing of delivering EBM content within the broader medical curriculum. Further research is required to determine the effects of timing, content and length of EBM courses and teaching methods.