Table 2 Characteristics of included studies
From: Methods of teaching evidence-based practice: a systematic review
Reference | Methods | Participants | Teaching interventions | Outcomes | Findings |
|---|---|---|---|---|---|
RG Badgett, JL Paukert and LS Levy [23] | Two quasi-randomised controlled studies in the USA | Study 1 (97–98): 159 3rd year undergraduate medical students: • Intervention (n = 63) • Control (n = 96) | Intervention: 6-h course on how to find and appraise medical evidence with the assistance of a customised computer user interface. The interface included EBM search resources such as Medline, Database of Abstracts of Reviews of Effectiveness (DARE) Control: students who had not yet received instruction | Skills assessed via a non-validated 3-item self-report survey | No difference between groups |
Study 2 (99–00): 151 3rd year undergraduate medical students: • Intervention (n = 84) • Control (n = 67) | Intervention: 5½-hour course on how to find and appraise evidence using resources accessible via an online portal/website with a focus on SUMsearch. SUMsearch automates searching for medical evidence sourcing the best available evidence Control: students who had not yet received instruction | Skills assessed via a non-validated 4-item self-report survey | No difference between groups Frequency and satisfaction with searching were higher in Study 2 | ||
P Bradley, C Oterholt, J Herrin, L Nordheim and A Bjorndal [24] | Randomised controlled trial in Norway | 175 10th semester undergraduate medical students: • Directed (n = 90) • Self-directed (n = 85) | Content, including question framing, literature searching, critical appraisal, application and evaluation of evidence was consistent across both interventions Directed: five 3-h workshops, led by a tutor, covering pre-specified topics Self-directed: a CD, in which the syllabus of the five workshops was outlined, together with teaching materials. Contact with tutors was permitted during the self-directed learning intervention | Knowledge assessed via a non-validated 18-item MCQ tool Attitudes assessed via a 7-item Likert questionnaire based on Taylor et al. [25] Critical appraisal skills assessed via non-validated 60-min exam | No difference between groups |
D Cardoso, F Couto, AF Cardoso, E Bobrowicz-Campos, L Santos, R Rodrigues, V Coutinho, D Pinto, M-A Ramis, MA Rodrigues, et al. [26] | Cluster randomised control trial in Portugal | 148 8th semester undergraduate nursing students: • Intervention (n = 74) • Control (n = 74) | Intervention: education as usual plus EBP Education program [27] which addressed models of thinking about EBP, and the types and steps of systematic reviews. Delivery occurred over 17 weeks with three four-hour classroom sessions and three two-hour mentoring sessions with a ratio of one mentor to two–three students Control: education as usual | Knowledge and skills assessed via adapted Fresno tool [28] | Greater improvements in knowledge and skills in the intervention group |
HM Cheng, FR Guo, TF Hsu, SY Chuang, HT Yen, FY Lee, YY Yang, TL Chen, WS Lee, CL Chuang, et al. [29] | Randomised controlled trial in Taiwan | 94 1st year undergraduate medical students: • Intervention (n = 47) • Control (n = 47) | All students took part in a 2-week EBM-course during general medicine clinical rotations. Students were also requested to engage in self-directed learning via the provided on-line and e-learning material Intervention: two 1-h structured case conferences addressing the principles and practical applications of EBP Control: no structured case conferences | Knowledge, attitudes, and behaviours assessed by the KAB questionnaire [30] | Higher knowledge and personal application behaviour scores within the intervention group No difference between groups in attitudes or future use behaviours |
J Davis, S Crabb, E Rogers, J Zamora and K Khan [31] | Randomised controlled trial in the UK | 1st year undergraduate medical students: • Computer-based (n = 70) • Lecture-based (n = 109) | Teaching duration (40-min) and content was consistent across both interventions including question framing, literature searching, critical appraisal of systematic reviews and meta-analysis and application of findings Computer-based: utilisation of the slides from the lecture-based teaching, with audio over-dubbing and guidance for use on a computer Lecture -based: typical linear lecture format delivered by the same tutor, with opportunities for questions at the end | Knowledge assessed via questionnaires based on the Berlin [32] and Fresno [33] tools Attitudes assessed via a 6-item Likert questionnaire [25] | No difference between groups |
JD Eldredge, DG Bear, SJ Wayne and PP Perea [34] | Stratified randomised controlled trial in the USA | 71 1st year medical students: • Intervention (n = 47) • Control (n = 24) | All students received EBM training which consisted of a 1-h lecture, and training labs focusing on searching skills Intervention: students had to assess and provide feedback on their peers’ searches Control: no peer-assessment or feedback | PubMed searching skills assessed via a non-validated test | No difference between groups |
T Hadvani, A Dutta, E Choy, S Kumar, C Molleda, V Parikh, MA Lopez, K Lui, K Ban and SS Wallace [35] | Randomised controlled trial in the USA | 127127127medical students • Intervention (n = 67) • Control (n = 60) | All students receive the same EBM curriculum delivered as Intervention: electronic self-paced module with voice over narration and short quizzes throughout the module (approx. 90 min) Control: 60 min traditionally didactic session consisting of a PowerPoint presentation with case examples and discussion delivered by faculty | Critically Appraise Topic (CAT) forms based on Fresno tool [33] Knowledge, attitudes and confidence based on the KACE questionnaire [36] | No difference between groups |
D Ilic, K Tepper and M Misso [37] | Randomised controlled trial in Australia | 97 3rd year undergraduate medical students: • Intervention (n = 60) • Control (n = 37) | Intervention: 2-h literature searching skills workshop delivered by a trained subject librarian, which focused on constructing a clinical question and searching the medical literature Control: students were provided with the same workshop upon conclusion of the study | Skills assessed by the Fresno tool [33] and the EBPQ questionnaire [38] | No difference between groups in skills |
D Ilic, RB Nordin, P Glasziou, JK Tilson and E Villanueva [39] | Mixed methods randomised controlled trial in Australia and Malaysia | 147 3rd year undergraduate medical students: • Intervention (n = 73) • Control (n = 74) | Intervention: blended learning involving a combination of lecture/tutorial, online and mobile learning. Online components preceded classroom activities and mobile learning occurred on wards Control: classroom teaching only, no online or mobile learning | Attitudes and behaviours assessed via the ACE tool [40] Skills assessed via the Berlin questionnaire [32] | No difference in skills, some differences between groups on specific sub-questions relating to behaviour, attitudes and self-efficacy |
HL Johnson, P Fontelo, CH Olsen, KD Jones, 2nd and RW Gimbel [41] | Randomised controlled trial in the USA | 35 1st or 2nd year graduate family nurse practitioner students: • Abstracts only (n = 19) • Full-texts and abstracts (n = 16) | Abstracts only: use of internet accessible search tool (EBN-search) accessed via iPad. Search results provided as abstracts Full-texts and abstracts: search results provided as abstracts and full-text manuscripts | Attitudes assessed via a non-validated Likert questionnaire | No between group differences |
JM Johnston, CM Schooling and GM Leung [42] | Randomised controlled crossover a trial in Hong Kong | 129 2nd year undergraduate medical students: • PBL (n = 70) • Usual teaching (n = 59) | Teaching content was the same in both interventions addressing the steps of EBP: ask, access, appraise, assess, apply Problem based learning (PBL): two 2-h small group PBL case format sessions facilitated by a faculty tutor Usual teaching: one 2-h interactive teaching lesson led by a clinically qualified faculty member and one 2-h small group meeting facilitated by a faculty tutor | Knowledge, attitudes, and behaviours assessed via the KAB questionnaire [30] | Higher attitude scores with usual teaching No difference in knowledge and behaviours between groups |
LA Kloda, JT Boruff and AS Cavalcante [43] | Randomised controlled trial in Canada | 64 undergraduate occupational or physiotherapy students near the end of their degree: • Alternative clinical question framework (n = 30) • PICO framework (n = 34) | All students received training about the categories of question types, selection of information resources based on these categories, and advanced search skills in the MEDLINE database in a 90-min session delivered by the same librarian instructor. The only difference between the two groups was the clinical question framework taught and used | Search performance assessed via comparison to gold standard references set. Search skills assessed via a modified Fresno tool [33] | No difference between groups |
D Koufogiannakis, J Buckingham, A Alibhai and D Rayner [44] | Randomised controlled trial in Canada | 164 1st year undergraduate medical and dental students: • Intervention (n = 6 groups) • Control (n = 12 groups) | All students had a 3-h lecture encompassing the principles of EBM (i.e. asking an answerable question, levels of evidence and decision making) and took part in weekly 4-h PBL sessions over the course of 6 weeks. Intervention: PBL sessions were attended by a librarian to provide advice to groups Control: PBL sessions without a librarian | Knowledge assessed via a non-validated 10-item MCE tool Attitudes assessed via a non-validated 5-item Likert questionnaire | Higher knowledge scores in the intervention No differences in attitudes between groups |
PM Krueger [45] | Randomised controlled trial in the USA | 77 3rd year undergraduate osteopathic medical students: • Intervention (n = 38) • Control (n = 39) | Intervention: 6-h of EBM critical appraisal training consisting of group workshops and lectures Control: no EBM training | Knowledge assessed via non-validated exam questions | Higher exam scores in the intervention group |
GM Leung, JM Johnston, KY Tin, IO Wong, LM Ho, WW Lam and TH Lam [46] | Randomised controlled crossover trial in Hong Kong | 168 4th year undergraduate medical students: • InfoRetriever (n = 54) a • Pocket card (n = 59) a • Control (n = 55) a | Two 2-h interactive sessions addressing the principles and practice of EBM and use of the InfoRetriever or pocket card InfoRetriever: software that provides access to relevant, current and best medical evidence via a personal digital assistant. Students were also provided with a digital version of the pocket card Pocket card: guidelines on clinical decision making and EBM techniques Control: no intervention | Behaviours assessed via the KAB questionnaire [30] | Higher scores for personal and current and future use of EBM with progression from control to pocket card and pocket card to InfoRetriever |
JD Long, P Gannaway, C Ford, R Doumit, N Zeeni, O Sukkarieh-Haraty, A Milane, B Byers, L Harrison, D Hatch, et al. [47] | Mixed-method randomised controlled trial in the USA and the Middle-East | 68 undergraduate nutrition and 60 PharmD students: • Intervention (n = 58) • Control (n = 70) | Intervention: use of a web-based evidence-based research (EBR) tool that provided a guide for searching and critical appraisal and links to resources Control: no EBR tool | Skills assessed via a Likert question based on the RRSA [48], and four non-validated questions | Greater improvement in research skills (nutrition students) and ability to distinguish credibility of online sources (PharmD students) in the intervention groups No difference between groups in other measures |
E Nango and Y Tanaka [49] | Randomised controlled trial in Japan | 17 4th, 5th, or 6th year undergraduate medical students: • Multidisciplinary (n = 7) • Medical-only (n = 10) | 2-day PBL EBM program addressing topics such as question construction, literature searching, critical appraisal and application Multidisciplinary: medical students participated in groups which included medical, nursing and pharmacy students Medical-only: groups included medical students only | Knowledge assessed vid a non-validated 12-item tool | No difference between groups |
M Sanchez-Mendiola, LF Kieffer-Escobar, S Marin-Beltran, SM Downing and A Schwartz [50] | Randomised controlled trial in Mexico | 95 5th year undergraduate medical students: • Intervention (n = 47) • Control (n = 48) | Intervention: 14 two-hour weekly EBM sessions involving large group interactive sessions, small group problem-solving activities, and informatics laboratory sessions Control: students who had not yet received instruction | Knowledge and attitudes assessed via Taylor et al. [25] Knowledge was also assessed via validated a 100-item MCQ test | Higher knowledge and attitude scores and reported use of original research articles and confidence level of critical appraisal skills in the EBM group |
K Schilling, J Wiecha, D Polineni and S Khalil [51] | Randomised controlled trial in the USA | 237 3rd year undergraduate medical students: • Intervention (n = 134) • Control (n = 103) | Intervention: students received an online clerkship programme during their 6-week family medicine clerkship. Content addressed the construction of clinical questions, literature searching and appraisal Control: no EBM intervention | Knowledge and skills assessed via a non-validated survey Skills assessed via a case problem | Higher skills scores in the intervention group |
MA Stack, NO DeLellis, W Boeve and RC Satonik [52] | Randomised controlled trial in the USA | 60 1st year graduate physician assistant students: • Intervention (n = 30) • Control (n = 30) | Intervention: 16 two-hour weekly EBM sessions involving a variety of teaching techniques (e.g. lectures, small group learning) Control: students who had not yet received instruction | Behaviours assessed via the PECA scale Skills assessed by the Fresno tool [33] and validated EBM self-efficacy scale | Higher knowledge and skills scores and self-efficacy in the intervention group No differences in behaviours between groups |
IS Widyahening, A Findyartini, RW Ranakusuma, E Dewiasty and K Harimurti [53] | Randomised crossover trial in Indonesia | 220 4th year undergraduate medical students: • Near-peer tutored (n = 161) a • Staff tutored (n = 59)a | All students took part in a CE-EBM module delivered over 4-weeks involving lectures, plenary presentations and four 2-h tutorials. All tutors completed 3-day teacher training prior to facilitating tutorials Near-peer tutored: newly graduate medical doctor volunteers who had passed the CE-EBM module and practiced using EBM during their clerkship Staff tutored: experienced medical staff who had participated in a 2 or 3-day EBM course and practiced EBM clinically | Knowledge and attitudes assessed based on the Fresno [33] & Berlin [32] tools Skills assessed via the EPIC scale [54] | No differences between groups |