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Table 1 Description of evidence for aspects of Evidence-Based Practice teaching and assessment

From: Sicily statement on evidence-based practice

Educational outcome Examples of methods of teaching Examples of methods of assessment
Translation of uncertainty into an answerable question. The student identifies knowledge gaps during the course of practice and asks foreground questions to fill these gaps, The student should ask focused questions that lead to effective search and appraisal strategies. Presenting clinical scenarios or asking for students to share a problem encountered in clinical practice. Framing a focussed, answerable question in a structured format [38]. Several formats are taught: 3 part (patient-intervention-outcome), 4 part (patient-intervention/exposure-comparator-outcome), or 5 part (patient-intervention/exposure-comparator-outcome-time) questions. The skills can be assessed by presenting a clinical scenario and asking the student to form a focussed, answerable question (included in the Fresno test) [53].
Search for and retrieval of evidence. The student can design and conduct a search strategy to answer questions. The strategy should be effective and comprehensive: likely to retrieve all relevant evidence. The student understands the strengths and weaknesses of the different sources of evidence. Theoretical instruction backed by a supervised practical session with online connection [39]. A variety of databases should be shown such as Cochrane, MEDLINE, CINAHL, Evidence-Based Medicine, SumSearch, with the relative benefits discussed. Computer based OSCE has been used to test the abilities of framing questions, searching, and retrieving appropriate evidence [54].
Critical appraisal of evidence for validity and clinical importance. The student can appraise the validity of a study. The appraisal will include: the suitability of the type of study to the type of question asked, the design of the study and sources of bias, the reliability of outcome measures chosen, and the suitability and robustness of the analysis employed. The student can appraise the importance of the outcomes and translate them into clinically meaningful summary statistics, such as number needed to treat (NNT). This is probably the most widely taught skill [55]Examples include the Critical Appraisals Skills Program [56]. Tests for critical appraisal of validity include the Berlin Questionnaire [57] and the Fresno test.
Application of appraised evidence to practice The student can assess the relevance of the appraised evidence to the need that prompted the question. The student can explore the patient's values and the acceptability of the answer. Examples include applying the identified evidence to the specific context that led to the quest for evidence. This requires exploration of the generalisability of the evidence to the specific scenario, and 'particularising' outcomes by adjusting for patient-specific risks[58]. Objective structured clinical examination involving clinical application and interaction with patient after reading supplied evidence [59].
Evaluation of performance. The student asks focussed questions, searches sources of evidence, appraises or uses pre-appraised evidence and applies these in practice. The student reflects on how well these activities are performed. Role modelling by EBP teachers. The encouragement of adult learning styles. Journal clubs [60]. Use of a questionnaire to assess knowledge, attitude and behaviour [61].