Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability.
OBJECTIVE
To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal.


METHODS
Firm-based, controlled trial.


METHODS
Urban public hospital.


METHODS
Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group.


METHODS
An EBM course, taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills.


RESULTS
The main outcome measure was performance on an EBM skills test that was administered four times over 11 months: at baseline and at three time points postcourse. Postcourse test 1 assessed the effectiveness of the intervention in the experimental group (primary outcome]; postcourse test 2 assessed the control group after it crossed over to receive the intervention; and postcourse test 3 assessed durability. Baseline EBM skills were similar in the two groups. After receiving the EBM course, the experimental group achieved significantly higher postcourse test scores (adjusted mean difference, 21%; 95% confidence interval, 13% to 28%; P < .001). Postcourse improvements were noted in three of the four EBM skill domains (formulating questions, searching, and quantitative understanding [P < .005 for all], but not in critical appraisal skills [P = .4]). After crossing over to receive the educational intervention, the control group achieved similar improvements. Both groups sustained these improvements over 6 to 9 months of follow-up.


CONCLUSIONS
A brief structured educational intervention produced substantial and durable improvements in residents' cognitive and technical EBM skills.
Smith
C A
CA
Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Ill. 60612, USA. csmith8@rush.edu
Ganschow
P S
PS
Reilly
B M
BM
Evans
A T
AT
McNutt
R A
RA
Osei
A
A
Saquib
M
M
Surabhi
S
S
Yadav
S
S
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric