Methods for teaching evidence-based practice: a scoping review

Background This scoping review aims to gather and map inspiration, ideas and recommendations for teaching evidence-based practice across Professional Bachelor Degree healthcare programmes by mapping literature describing evidence-based practice teaching methods for undergraduate healthcare students including the steps suggested by the Sicily Statement. Methods A computer-assisted literature search using PubMed, Cinahl, PsycINFO, and OpenGrey covering health, education and grey literature was performed. Literature published before 2010 was excluded. Students should be attending either a Professional Bachelor’s degree or a Bachelor’s degree programme. Full-text articles were screened by pairs of reviewers and data extracted regarding: study characteristics and key methods of teaching evidence-based practice. Study characteristics were described narratively. Thematic analysis identified key methods for teaching evidence-based practice, while full-text revisions identified the use of the Sicily Statement’s five steps and context. Results The database search identified 2220 records. One hundred ninety-two records were eligible for full-text assessment and 81 studies were included. Studies were conducted from 2010 to 2018. Approximately half of the studies were undertaken in the USA. Study designs were primarily qualitative and participants mainly nursing students. Seven key methods for teaching evidence-based practice were identified. Research courses and workshops, Collaboration with clinical practice and IT technology were the key methods most frequently identified. Journal clubs and Embedded librarians were referred to the least. The majority of the methods included 2–4 of the Sicily Statement’s five steps, while few methods referred to all five steps. Conclusions This scoping review has provided an extensive overview of literature describing methods for teaching EBP regarding undergraduate healthcare students. The two key methods Research courses and workshops and Collaboration with clinical practice are advantageous methods for teaching undergraduate healthcare students evidence-based practice; incorporating many of the Sicily Statement’s five steps. Unlike the Research courses and workshop methods, the last step of evaluation is carried out partly or entirely in a clinical context. Journal clubs and Embedded librarians should be further investigated as methods to reinforce existing methods of teaching. Future research should focus on methods for teaching EBP that incorporate as many of the five steps of teaching and conducting EBP as possible.


Background
Dizon et al. state that healthcare can be inefficient, ineffective and/or dangerous when it is not based on current best evidence [1,2]. Therefore, to ensure the quality of healthcare, it is important to implement evidence-based practice (EBP) in all health professional curricula, so that future health professionals learn the fundamentals of research and the application of evidence in practice [2].
Several definitions of EBP have been suggested in recent years. The scientific evidence was initially developed within medicine, but as many health professionals have embraced an evidence-based way of practice the Sicily Statement [3] suggested that the original term "evidencebased medicine" should be expanded to "evidence-based practice" in order to reflect a common approach to EBP across all health professions.
The Sicily Statement gives a clear definition of EBP together with a description of the minimum level of educational requirements and skills required to practice in an evidence-based manner. This makes the underlying processes of EBP more transparent and distinguishes between the process and outcome of EBP [3].
In order to fulfil the minimum requirements of teaching and conducting EBP, the Sicily Statement puts forward a five-step model: (I) asking a clinical question; (II) collecting the most relevant evidence; (III) critically appraising the evidence; (IV) integrating the evidence with one's clinical expertise, patient preferences and values to make a practice decision; and (V) evaluating the change or outcome [4].
Internationally, EBP skills are essential requirements in clinical practice among both medical doctors as well as among other health professionals. Healthcare students are mainly taught the first three steps of the Sicily Statement's five-step model. The last two steps are rarely taught, and students and graduates thus lack competencies in applying their knowledge in the clinical setting during or after graduation [5,6].
In terms of healthcare policy and ambitions in Denmark, it was decided in 2015 that Professional Bachelor Degree healthcare students were to contribute to the development of an evidence-based way of working, a faster implementation of new knowledge in practice, and to the development of greater patient involvement and patient safety in the Danish healthcare system [7]. The Professional Bachelor's degree is awarded after 180-270 ECTS and includes a period of work placement of at least 30 ECTS. The programmes are applied programmes. They are development-based and combine theoretical studies with a practical approach. Examples of professional bachelor degree holders are nurses. The Danish title is Professionsbachelor and the English title is Bachelor [8]. In Denmark the University College institutions solely provide professional bachelor degree educations. Master degrees are awarded at the Universities.
Based on the Sicily Statement students should be able to reflect, ask questions, gather knowledge, critically appraise, apply and evaluate various kinds of knowledge at the end of their course. The aim is that all Professional Bachelor Degree healthcare students across disciplines of nursing, physiotherapy, occupational therapy, radiography, and biomedical laboratory science develop common EBP qualifications in order to contribute towards the development of evidence-based healthcare [9]. In order to ensure shared prerequisites and mutual understanding of the EBP concepts before entering theoretical or clinical interprofessional education, further knowledge about how to teach EBP across disciplines is required [9]. By teaching the fundamental principles of EBP, students will develop their EBP skills and ability to put them into practice in their studies and as future graduates.
In a review from 2014, Young and colleagues stated that multifaceted interventions integrated into clinical practice contributed to the greatest improvements in EBP knowledge, skills, and attitudes [2]. In line with this, Kyriakoulis et al. suggested that a combination of interventions, such as lectures, tutorials, workshops, conferences, journal clubs, and online sessions was best suited for teaching EBP to undergraduate healthcare students [10]. However, the majority of the articles in both reviews synthesized information from interventions or strategies aimed at medical students at various educational levels. Only a few articles elicited information about educational interventions and strategies aimed at undergraduate healthcare students in the disciplines of nursing, physiotherapy, occupational therapy, radiography, and/or biomedical laboratory science. However, two recent reviews have specifically addressed EBP teaching for undergraduate nursing students [11,12]. A systematic review investigated the effectiveness of specific educational methods and found an effect on student knowledge, attitudes, and skills but could not draw a conclusion as to the advisability of one of the methods [11]. A literature review sought to identify knowledge experiences on teaching strategies from qualitative studies in nursing EBP education to enhance knowledge and skills and points to a limited focus on the use of EBP teaching strategies. Additionally, the study points to the need for more qualitative research investigating interactive and clinically integrated teaching strategies. Despite both reviews being well-informing, a broad scope when mapping updated EBP teaching methods and strategies across healthcare bachelor educations will further qualify future interdisciplinary practices [11,12].
In order to implement the most effective ways of teaching EBP across healthcare undergraduate students, an investigation of existing literature on the subject needs to be undertaken. For identifying, mapping and discussing key characteristics in the literature a scoping review is the better choice [13].

Aim, objectives and review question
The aim of this scoping review is to gather and map inspiration, ideas, and recommendations for teachers implementing EBP across Professional Bachelor Degree healthcare programmes by mapping existing literature describing EBP teaching methods, including the five steps of EBP suggested by the Sicily Statement, [3] regarding undergraduate healthcare students.
The primary question of the scoping review is: "Which EBP teaching methods, including The Sicily Statement's steps of teaching and conducting EBP, have been reported in the literature with respect to undergraduate healthcare students in classrooms and clinical practice?"

Definitions
Classroom is defined as a room where classes are taught in a school, college or university [14].
Clinical practice refers to the agreed-upon and customary means of delivering healthcare by doctors, nurses and other health professionals [15].

Methods
To ensure a systematic methodology, The Joanna Briggs Institute Reviewers' Manual -Methodology for JBI Scoping Reviews has been used throughout the scoping review process [16,17].

Inclusion criteria Participants
Literature which included undergraduate healthcare students in the disciplines of nursing, physiotherapy, occupational therapy, radiography, and biomedical laboratory science was selected to ensure applicability and relevance to similar scientific disciplines at other institutions of higher education. The undergraduate students should be attending either a Professional Bachelor's degree or a Bachelor's degree programme.

Concept
Methods for teaching EBP including The Sicily Statement's steps of teaching and conducting EBP was the main concept to be investigated in the review. That is; literature describing either recommendations of EBP teaching methods, evaluations of EBP teaching methods, teacher and/or student perceptions of EBP teaching and learning methods, or qualifications obtained when learning the principles of EBP.

Context
Literature describing methods for teaching EBP conducted in a classroom setting, in clinical practice as part of the education, or in a combination of classroom and clinical practice was included in the review.

Exclusion criteria
In the period up to 2010, the Bachelor Degree healthcare educations began to conform to European requirements regarding evidence-informed and evidence-based education [18].
A maximum time frame (2010-2018) was applied, determined by the amount of available literature/research studies and requirements of updated teaching strategies [19,20]. Therefore, literature published before 2010 was excluded.
Literature including undergraduate students in other health disciplines such as medicine or dentistry was not reviewed as the structure of their education is based on another paradigm. Nor was literature including participants such as graduates, RN-to-BSN students, and trained health personnel accepted for inclusion as they were considered as postgraduates, not comparable to undergraduate students. With the primary aim of gathering ideas and inspiration for teaching EBP, literature that focused on issues other than methods for teaching EBP was excluded, as well as literature in languages other than English, Danish, Norwegian, or Swedish.

Search strategy
To identify literature relevant to our research question, the databases MEDLINE via PubMed, CINAHL Complete, and PsycINFO (both via EBSCO) were systematically searched. These databases cover both health and education and are available to the primary local target audience of this scoping review. Because of time limitations only the multidisciplinary European database, OpenGrey, was searched in the attempt to find unpublished literature. The searches were conducted May 9th, 2018.
As recommended in The Joanna Briggs Institute Reviewers' Manual [16,17], the search was conducted in three steps in collaboration with a research librarian.
Step 2: Through an analysis of text words in titles and abstracts of the studies found in PubMed and Cinahl, new keywords, which would improve the search, were identified. These were 'allied health' , health students' , and 'nursing'. All identified keywords were then included in the search as a systematic block search in PubMed, Cinahl, and PsycINFO, covering literature in the behavioural and social sciences, and OpenGrey, covering grey literature in Europe. Table 1 provides a list of the specific search queries used in all databases.
Step 3: The reference lists of identified studies were searched for additional studies.

Study selection
All search results from the databases were imported to the web-based bibliographic management software, RefWorks 2017 by ProQuest. After exclusion of duplicates and records before 01.01.2010, two reviewers independently screened titles and abstracts of the remaining articles for relevance in relation to the research question and the inclusion and exclusion criteria. Afterwards, all full-text articles were further checked for relevance by two independent reviewers. Any inconsistencies between the two reviewers regarding study selection for final inclusion were resolved by discussion with a third reviewer.

Data collection
Data from the included articles were extracted using two data extraction tools as recommended in The Joanna Briggs Institute Reviewers' Manual [16,17]. The first data extraction tool comprised study characteristics, while the other data extraction tool comprised methods for teaching EBP.
Prior to the process of extracting data from the included articles, a pilot test using the data extraction tools was conducted by one reviewer assessing nine articles. To ensure agreement between reviewers, a second reviewer checked the same articles. Any disagreements about the content or use of the data extraction tools were discussed and resolved.
One reviewer then extracted relevant data from all included articles to the data extraction tools. Two other reviewers split the same articles among them and extracted data using the same data extraction tools. As a final step, the first reviewer went through all extracted data from all of the included articles with each of the other reviewers to ensure comparability and completeness in the final data extraction tools.

Synthesis and analysis of results
The data extraction tools formed the basis of the final presentation of the results in two tables consisting of "Study characteristics" and "Key methods for teaching EBP, the Sicily Statement's five steps of teaching and conducting EBP and context". Study characteristics included author, year of publication, title, journal, country of origin, study design, study participants, methods for teaching EBP, and main study findings. The key methods for teaching EBP were identified through a thematic analysis. All full text articles were read and every teaching method found was listed. Through a revision of all teaching methods listed, seven themes were found that described the most prominent teaching methods, which were named "Key methods for teaching EBP". All methods were then divided into one of the key methods for teaching EBP. In some articles, more than one teaching method was described. In that case, the teaching method most frequently described was selected and categorised under the relevant key method. Through full-text revision the Sicily Statement's steps of teaching and conducting EBP and the context (classroom, clinical practice or a combination of both) in which the teaching took place was found. To further clarify the content of the two tables all results listed were described narratively. All tabulated data, except for the key methods for teaching EBP identified in Table 3, have been cited directly from the articles.

Literature search
The database search returned 2220 records: PubMed (n = 1469), Cinahl (n = 527), PsycINFO (n = 173), and OpenGrey (n = 51) (Fig. 1). Records published before 01.01.2010 and duplicates were removed, which left 1280 records to be screened by title and abstract. Based on relevance, 1088 records were excluded and 192 records were found eligible for full-text assessment. In accordance with the inclusion and exclusion criteria, 111 articles were excluded. The excluded articles concerned study participants other than undergraduate healthcare students (graduates, RN-to-BSN students, trained health personnel), study participants from other healthcare disciplines (medicine, dentistry, midwifery), issues other than methods for teaching EBP (simulation teaching, community health nursing, EBP beliefs, etc.), and full-text articles not available in English, Danish, Norwegian, and Swedish (French, Chinese). In agreement with the other reviewers, 81 studies were finally included in the scoping review.
Key methods for teaching EBP, the Sicily Statement's five steps of teaching and conducting EBP and context Table 3 presents the key methods for teaching EBP, the Sicily Statement's five steps of teaching and conducting EBP, and the context. Seven key methods for teaching EBP were identified: Thirty-two studies described "Research courses and workshops". "Collaboration with clinical practice" was identified 14 times followed by "IT technology" (n = 8), "Assignments" (n = 5), "Participation in research projects" (n = 5), "Journal clubs" (n = 2), and "Embedded librarians" (n = 2). In addition, 13 studies described various theories of teaching and learning. These are not elaborated on as the theme is not considered within the objective of this scoping review.
In Table 3 the vast majority of the studies (n = 69) referred to one or more of the Sicily Statement's five steps of teaching and conducting EBP. Eleven studies referred to all five steps. Thirty-one studies referred to three or four steps, while 17 studies referred to two of the steps,    The workshop approach provides students with a "safe" place to explore their assumptions, learn from peers, and make a leap forward along their personal learning curve as writers.
Doyle [36] 2016          it enabled them to progress to more abstract and complex applications.
Yu [99] 2013 Improvement in critical thinking dispositions of undergraduate nursing students through problem-based learning: a crossover-experimental study Journal of Nursing Education China Quantitative Nursing students One group receiving problem-based learning (PBL) and the other group receiving lecture-based learning (LBL) as a control PBL is an effective method to improve the quality of medical teaching and the abilities of nursing students, as well as a means to improve implementation of knowledge, ability, and quality, but it also presents an effective means to improve critical thinking dispositions in nursing students in China.
Zhang [100]       Collaboration with clinical practice Students were encouraged to write a clinical question using PICOT. The group was divided into teams who shared the responsibilities for searching and reporting EBP information that supported or refuted current practice. As a team students discussed relationships among laboratory concepts, current practice, and EBP information found in literature. By using post-conference time immediately following clinical practice experiences, students could associate their personal experiences in practice with the EBP information.    Theories of teaching -and learning The pedagogical strategies presented invite the learner to become an active participant in the learning activity, e.g. assessing research, conducting a research project and assessing patients' requirements for healthcare. This means that they are encouraged to use discretion to solve ill-structured problems related to the steps of EBP, the research process and their own clinical practice. Another strategy to enhance students' interest and make the learning tasks relevant is to link the learning task to real clinical situations  Theories of teaching -and learning Classroom and ten studies described one step. Twelve studies had no description of any of the steps. The steps most often referred to were step two, three, and four.
Step two, "Collect the most relevant evidence", was mentioned in 58 studies.
Step three, "Critically appraise the evidence", was referred to in 55 studies, while step four, "Integrate the evidence with one's clinical expertise, patient preferences, and values to make practice decision", was mentioned in 51 studies.
Step one, "Ask a clinical question", and step five, "Evaluate change or outcome" was referred to in 36 and 14 studies, respectively. Seven out of the eleven studies referring to all of the Sicily Statement's five steps were identified under the key methods "Research courses and workshops" and "Collaboration with clinical practice".
The context in which the studies were conducted was primarily classroom settings (n = 52). Twenty studies described context as a combination of classroom and clinical practice, and nine studies were conducted in clinical practice.
Out of the 68 studies which included the seven key methods, 24 out of 32 "Research courses and workshops" were conducted in classrooms, while "Collaboration with clinical practice" was conducted in a combination of classroom and clinical practice (n = 6), clinical practice (n = 5), or classrooms (n = 3). "IT technology" was used in classrooms (n = 6) or clinical practice (n = 2). "Assignments" were conducted in classroom settings only (n = 5), while "Participation in research projects" took place in a combination of classroom and clinical practice (n = 3), classroom (n = 1) or clinical practice (n = 1). "Embedded librarians" (n = 2) and "Journal clubs" (n = 2) both took place in classroom settings.

Discussion
This study provides an overview of existing EBP teaching methods including The Sicily Statement's steps of teaching and conducting EBP with respect to undergraduate healthcare students both in classrooms and in clinical practice.
It is beyond the scope of this review to interpret all the findings of the included studies. The findings discussed below are the key methods most frequently identified in the thematic analysis: "Research courses and workshops" and "Collaboration with clinical practice", as well as the key methods most positively referred to in main findings of the studies: "IT technology", "Embedded librarians", and "Journal clubs". Despite the scarce use of the last three methods ("IT technology", "Embedded librarians", "Journal clubs") these can however provide ideas for how to teach EBP in the future. Furthermore, the scoping review provides useful information as to which of the Sicily Statement's five steps of teaching and conducting EBP are taught in the various methods and whether one particular method is more useful and applicable than others in a particular learning setting, depending on the context and the learning outcomes. Lecturers, senior lecturers and others who teach EBP at undergraduate healthcare educational institutions can benefit from this information and gain inspiration and ideas for teaching EBP. We are aware that other studies have addressed issues such as teachers' competencies required for teaching EBP, which we do consider important in order to standardise and improve education in EPB. Interestingly, a study has identified specific sets of EBP core competencies for teachers, which are classified within the 5-step model of EBP [101]. However, since our primary focus was on methods for teaching EBP to undergraduate healthcare students the aspect of teacher's competencies has not been further investigated.
Overall, the first 4 steps of the Sicily Statement could more easily be identified. However the last and fifth step proved to be more difficult to identify which often is the case. Furthermore, our results tend to point to the fact that the fifth step is often more theoretically linked at the undergraduate level and that a more specified implemtation and evaluation of the EBP process takes place at a more advanced level.

Research courses and workshops
Research courses and workshops were the most frequently used methods for teaching EBP. The frequent use of this method is in agreement with the systematic review by Kyriakoulis et al., where eight of the 20 methods for teaching EBP were research courses, workshops or similar sessions [10] and Young et al., where three out of five methods used for teaching evidencebased healthcare (EBHC) were workshops [2]. The majority of the studies concerning "Research courses and workshops", referred to three or more of the Sicily Statement's five steps of teaching and conducting EBP [10, 23, 26, 31, 33, 40, 42, 44, 47-49, 53, 55-57, 59, 76, 90, 91, 96, 97, 100]. Despite the fact that the fifth step was included in some studies, it was not clear what was covered by the evaluation process, and additionally, if it was part of the students' assignment work alone or if there was a link to clinical practice. The majority of the research courses and workshops were conducted in classrooms. According to Young et al., EBHC courses can improve appraisal skills in nurses, occupational therapists and physiotherapists, among others [2]. However, further assessments and analyses of the courses and workshops found in this scoping review must be made to ensure that the content and outcomes are applicable in similar contexts.

Collaboration with clinical practice
In this scoping review, the key method for teaching EBP, "Collaboration with clinical practice" was identified 14 times in the thematic analysis. In comparison, "collaboration with clinical practice" is only mentioned once as a method for teaching EBP in the review by Young et al. [2] and not mentioned in the systematic review by Kyriakoulis et al. [10]. The results of this scoping review suggest that collaboration with clinical practice is a frequently used method for teaching EBP with respect to undergraduate healthcare students. The rare use of this method in the review by Kyriakoulis et al. and the review by Young et al. might be explained by the type of participants included in these reviews. Only two studies included undergraduate students in the disciplines of nursing, physiotherapy or occupational therapy: in the review by Young et al. and the review by Kyriakoulis [2,10]. Along this line, a review on teaching EBM to medical students found weak and inconsistent results from a limited number of studies on the effect of clinically integrated methods on knowledge, attitudes, and skills [102]. Collaboration with clinical practice might be more fundamental among undergraduate students in the disciplines of nursing, physiotherapy or occupational therapy, compared to undergraduate students in medicine primarily included in the other reviews [2,10].
Half of the studies identified in relation to "Collaboration with clinical practice", referred to four or five of the Sicily Statement's steps [38,43,70,73,80,87,89,93]. In two of the studies, the steps were taught directly in clinical practice as part of the students' clinical education [70,93], and unlike the research courses and workshops methods, the last step of evaluation of change or outcome is carried out either partly or entirely in a clinical context. The main findings of all eight studies indicate that collaboration with clinical practice is an effective way of teaching EBP, both with the combination of classrooms and clinical practice settings and in clinical practice settings alone. Despite being a recommended strategy in the literature, a recent literature review points to the fact that EBP teaching strategies including clinical activities in nursing students seems less prioritised [12].

IT technology
The key method, "IT technology", described tools, such as mobile devices, video resources and websites, among others, used in classrooms or clinical practice for seeking information in relation to EBP. In clinical practice, mobile devices were used to seek information regarding EBP search strategies, critical appraisal of clinical guidelines [66], and specific task-oriented information in relation to clinical practice [36]. Despite the reported improvement in knowledge and skills in relation to EBP and appraisal of clinical guidelines, the use of mobile devices was reported as low [66]. In classrooms, the use of IT technology as a method for teaching EBP was reported as mainly positive. Today, most students have access to IT equipment and this technology could be integrated in classrooms and clinical practice to seek information regarding EBP. In the review by Kyriakoulis et al. the results support our findings; that IT technology can be an effective method for teaching EBP with respect to undergraduate healthcare students [10].
Journal clubs "Journal Clubs" as a method for teaching EBP was only described in two studies in this scoping review. However, the findings indicated that the method improved students' skills in reading articles and understanding evidence-based nursing [60], and promoted competenceis needed to deliver evidence-based care [58]. The studies included two and three steps, respectively, proposed by the Sicily Statement [3]. Additional steps may advantageously be incorporated into future journal clubs to ensure the quality of healthcare. Young et al. referred to four reviews describing a positive effect of journal clubs as a method for teaching EBP [2]. However, none of the reviews included Professional Bachelor Degree healthcare students. Further studies must be conducted to assess the effectiveness of journal clubs as a method for teaching EBP in Professional Bachelor Degree healthcare courses and to study the opportunity of incorporating all of the Sicily Statement's five steps for teaching and conducting EBP.

Embedded librarians
In two studies librarians were introduced to teach students information literacy [74,77]. Librarians are experts in this field and are able to teach students the skills essential to EBP [74]. Librarians can support students in establishing and managing effective search techniques and help with reviewing and critiquing the information found. Thus, students develop information literacy skills as required in practice [77]. Research librarians who are embedded as part of a research course for teaching undergraduate healthcare students EBP may be an effective way of ensuring a complete introduction to the Sicily Statement's five steps of teaching and conducting EBP. The first three steps can be taught in classrooms, followed by practical exercises in the last two steps in clinical practice.

Implications for practice
The majority of the key methods found for teaching EBP were "Research courses and workshops" and "Collaboration with clinical practice", whereas "Journal Clubs" and "Embedded librarians" were identified only twice. The frequent use of research courses and workshops as methods for teaching EBP may stem from a tradition of classroom lectures and is a relatively manageable way to teach EBP. The findings from this scoping study however suggest that other methods for teaching EBP with respect to undergraduate students exist. Journal clubs could be incorporated as a supplement to classroom lectures or as part of collaboration with clinical practice. Librarians may advantageously be introduced in research courses and workshops. The librarians can help students gain control of EBP definitions and concepts, and master search techniques before entering clinical practice. The effect of journal clubs and embedded librarians on students' EBP competencies should however be investigated further before being incorporated into Professional Bachelor's Degree curricula.
EBP education based on the Sicily Statement's five steps, demanded both internationally and nationally, implies an introduction to all of the Sicily Statement's five steps of teaching and conducting EBP at undergraduate level [5,6,9]. At present, the majority of the methods found for teaching EBP only include 2-4 steps. In line with these results, a recent review found that the majority of evaluated EBP educational interventions are focused on a single step (step 3, critically appraising evidence) of the five steps of teaching and conducting EBP [103]. This research adds to the statement that an effort must be made to incorporate all five steps of the Sicily Statement in an educational and cooperative way in order to ensure that undergraduate healthcare students are qualified to work in an evidencebased manner.
We did not review available assessment methods for evaluation of EBP education interventions or programmes in this study. The additional importance of this field and the apparent lack of valid evaluation methods have been extensively highlighted in other studies and needs to be taken into account when applying methods for teaching EPB [104,105].

Strengths and limitations
The scoping review presents an updated overview of existing methods for teaching EBP with respect to undergraduate healthcare students, including study specific recommendations for teaching methods to be used in future curricula. It follows recommended guidelines for a priori design requirements and transparent reporting [13,16].
Limitations are however found in relation to the search strategy. Our search did not include literature published before 2010 and due to time constraints, a limited number of databases were searched, which entails the risk that not all relevant literature was identified. Furthermore, the search terms used identified primarily undergraduate nursing students, despite a thorough search for all undergraduate students in the disciplines of nursing, physiotherapy, occupational therapy, radiography, and biomedical laboratory science.
Other search terms might have captured these health disciplines to a greater extent. An alternative explanation for the large occurrence of studies regarding nursing students could be that there is a greater publishing tradition in this field. However, the methods for teaching EBP can to a certain extent, be introduced to undergraduate students in the other health disciplines.

Conclusion
Consistent with our objective, this scoping review has provided an extensive overview of literature describing methods for teaching EBP regarding undergraduate healthcare students. The two key methods most often identified were "Research courses and workshops" and "Collaboration with clinical practice". Despite the first method often being used in this scoping review, as well as in other reviews, fewer of the Sicily Statement's five steps of teaching and conducting EBP were referred to, and if the fifth step of evaluation of change or outcome was included, the description of content was often unclear.
On the contrary, "Collaboration with clinical practice", the second most used teaching method, more often referred to four or five steps, making this method an effective approach for teaching EBP while ensuring incorporation of several of the steps. Unlike the Research courses and workshop methods, the last step of evaluation is carried out partly or entirely in a clinical context.
Overall, our results tend to show that the evaluation step is often theoretically linked at the undergraduate level. Despite the small number of studies describing 'Journal clubs' and 'Embedded librarians' , these teaching methods could advantageously be incorporated in the classroom context and could ensure a complete introduction to all five steps.
On the basis of our findings, we argue that future research should focus on identifying methods for teaching EBP that incorporate as many of the Sicily Statement's five steps of teaching and conducting EBP as possible. Journal clubs and embedded librarians could be further looked into as methods to support the more established methods for teaching EBP across all undergraduate healthcare disciplines.