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Teaching evidence-based medicine skills can change practice in a community hospital

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Abstract

OBJECTIVES: Several studies have evaluated whether evidence-based medicine (EBM) training courses can improve skills such as literature searching and critical appraisal but to date, few data exist on whether teaching EBM skills and providing evidence-based resources result in change in behavior or clinical outcomes. This study was conducted to evaluate whether a multifaceted EBM intervention consisting of teaching EBM skills and provision of electronic evidence resources changed clinical practice.

DESIGN: Before/after study.

SETTING: The medical inpatient units at a district general hospital.

PARTICIPANTS: Thirty-five attending physicians and 12 medicine residents.

INTERVENTION: A multicomponent EBM intervention was provided including an EBM training course of seven 1-hour sessions, an EBM syllabus and textbook, and provision of evidence-based resources on the hospital network.

MEASUREMENTS AND MAIN RESULTS: The primary outcome of the study was the quality of evidence in support of therapies initiated for the primary diagnoses in 483 consecutive patients admitted during the month before and the month after the intervention. Patients admitted after implementation of the EBM intervention were significantly more likely to receive therapies proven to be beneficial in randomized controlled trials (62% vs 49%; P=.016). Of these trial-proven therapies, those offered after the EBM intervention were significantly more likely to be based on high-quality randomized controlled trials (95% vs 87%; P=.023).

CONCLUSIONS: A multifaceted intervention designed to teach and support EBM significantly improved evidence-based practice patterns in a district general hospital.

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References

  1. Majumdar SR, McAlister FA, Furberg CD. From publication to practice in chronic cardiovascular disease—the long and winding road. J Am Coll Cardiol. 2004;43:1738–42.

    Article  PubMed  Google Scholar 

  2. Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. CMAJ. 2000;163:837–41.

    PubMed  CAS  Google Scholar 

  3. Sauve J-S, Lee HN, Meade MO, et al. and the General Internal Medicine Fellowship Programme of McMaster University. The critically-appraised topic (CAT): a resident-initiated tactic for applying users’ guides at the bedside. Ann R Coll Physicians Surg Can. 1995;28:396–8.

    Google Scholar 

  4. Straus SE, Badenoch D, Richardson WS, Rosenberg W, Sackett DL. Practising Evidence-based Medicine. Oxford: Radcliffe Medical Press; 1998.

    Google Scholar 

  5. Sackett DL, Richardson WS, Rosenberg WMC, Haynes RB. Evidence-based Medicine: How to Practice and Teach EBM. London: Churchill Livingstone; 1997.

    Google Scholar 

  6. Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. Lancet. 1995;346:407–10.

    Article  PubMed  CAS  Google Scholar 

  7. Sibley JC, Sackett DL, Neufeld V, Gerrard B, Rudnick KV, Fraser W. A randomized trial of continuing medical education. N Engl J Med. 1982;306:511–5.

    Article  PubMed  CAS  Google Scholar 

  8. Michaud G, McGown JL, van der Jagt R, Wells G, Tugwell P. Are therapeutic decisions supported by evidence from health care research? Arch Intern Med. 1998;158:1665–8.

    Article  PubMed  CAS  Google Scholar 

  9. Langham J, Tucker H, Sloan D, et al. Secondary prevention of cardiovascular disease: the PIER trial. Br J Gen Pract. 2002;142:818–24.

    Google Scholar 

  10. Forsetlund L, Bradley P, Forsen L, et al. Randomised controlled trial of a theoretically grounded intervention to diffuse evidence-based public health service. BMC Med Educ. 2003;3:2.

    Article  PubMed  Google Scholar 

  11. Mant J, Hicks N. Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction. BMJ. 1995;311:793–6.

    PubMed  CAS  Google Scholar 

  12. Fisher BW, Hayward RSA, Lau FY. Use and perceptions of computerized health information resources by medical residents. Ann R Coll Physicians Surg Can. 2002;35:467–71.

    Google Scholar 

  13. Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the “evidence cart”. JAMA. 1998;280:1336–8.

    Article  PubMed  CAS  Google Scholar 

  14. Shin JH, Haynes RB, Johnston. Effect of problem-based, self-directed undergraduate education in lifelong learning. Can Med Assoc J. 1993;148:969–76.

    CAS  Google Scholar 

  15. McColl A, Smith H, White P, Field J. General practitioners’ perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998;316:361–5.

    PubMed  CAS  Google Scholar 

  16. McAlister FA, Graham I, Karr GW, Laupacis A. Evidence-based medicine and the practising clinician: a survey of Canadian general internists. J Gen Intern Med. 1999;14:236–42.

    Article  PubMed  CAS  Google Scholar 

  17. Hagdrup N, Falshaw M, Gray RW, Carter Y. All members of primary care team are aware of importance of evidence based medicine. BMJ. 1998;317:282.

    PubMed  CAS  Google Scholar 

  18. Ghali WA, Saitz R, Eskew AH, Lemaire JB, Gupta M, Hershman WY. Evidence-based medicine: behaviors, skills, and attitudes of medical students. Ann R Coll Physicians Surg Can. 1998;31:177–82.

    Google Scholar 

  19. Olatunbosun OA, Edouard D, Pierson RA. Physicians’ attitudes toward evidence based obstetric practice: a questionnaire survey. BMJ. 1998;316:365–6.

    PubMed  CAS  Google Scholar 

  20. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet. 2003;362:1225–30.

    Article  PubMed  Google Scholar 

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Correspondence to Sharon E. Straus MD, MSc, FRCPC.

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The authors have no conflicts of interest to report.

SES is supported by the Ontario Ministry of Health and the Knowledge Translation Program, University of Toronto; FAM is supported by the Alberta Heritage Foundation for Medical Research and the Canadian Institutes of Health Research.

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Straus, S.E., Ball, C., Balcombe, N. et al. Teaching evidence-based medicine skills can change practice in a community hospital. J GEN INTERN MED 20, 340–343 (2005). https://doi.org/10.1111/j.1525-1497.2005.04045.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.04045.x

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