Educating physicians in evidence based medicine: current practices and curricular strategies

INTRODUCTION: Evidence-based medicine (EBM) is an expectation of professional healthcare and a requisite component of medical school curricula. However, upon graduation medical students' EBM skills have been found lacking suggesting a need to examine EBM training. METHODS: This PhD report presents two studies on EBM education. The first study is a literature review that describes and attempts to assess educational interventions for teaching medical students EBM. The second study presents a multi-institutional case study conducted in North America using interviews and curricular materials to identify EBM instructors' perceptions of challenges that may impede medical students' efforts to learn EBM. RESULTS: The literature review analyzed 20 learning interventions from 12 countries that were presented in classrooms (75 %) and clinics (25 %). The steps of EBM were addressed to varying degrees. It was not possible to draw conclusions about the efficacy of the interventions due to lack of detailed reporting. The qualitative study identified four learning challenges: sub-optimal role models, student lack of willingness to admit uncertainty, lack of clinical context, and difficulty mastering EBM skills. To meet these challenges, participants described interventions such as integrating EBM skills with other content/courses, incorporating clinical content into EBM teaching, providing faculty development, using whole-task EBM activities, and longitudinal integration of EBM across the curriculum. CONCLUSION: This PhD report takes steps to describe and assess EBM learning interventions, presents student learning challenges and looks at approaches institutions take to meet them. Educators can use these findings to examine their curriculum and learning environments and, if desired, adopt them for their training.