Medical students' application of published evidence: randomised trial.
OBJECTIVE
To determine how medical students apply research evidence that varies in validity of methods and importance of results to a clinical decision.


METHODS
Students examined a standardised patient with a whiplash injury, decided whether to order a cervical spine radiograph, and rated their confidence in their decision. They then read one of four randomly assigned variants of a structured abstract from a study of a decision rule that argued against such a procedure in this patient. Variants factorially combined two levels of validity of methods (prospective cohort or chart review) with two levels of importance of results (high sensitivity or high specificity rule). After reading the abstract, students repeated their choice and rated their confidence.


METHODS
Academic medical centre in the United States.


METHODS
164 graduating medical students.


METHODS
Proportion of students in each group whose beliefs shifted or stayed the same.


RESULTS
When abstracts were of low importance students were more likely to shift their beliefs in favour of radiography, which was not supported by the evidence (odds ratio 3.42, 95% confidence interval 1.10 to 10.66). Neither methodological validity nor the interaction between validity and importance influenced decision shift. Few students acquired all necessary clinical data from the patient.


CONCLUSIONS
Although the students could apply concepts of diagnostic testing, greater focus is needed on appraisal of validity and application of evidence to a particular patient.
Schwartz
Alan
A
Department of Medical Education (M/C 591), 808 South Wood Street, 986 CME, University of Illinois at Chicago, Chicago, IL 60612-7309, USA.
Hupert
Jordan
J
D002983:Clinical Competence / Q000592:standards*; D003657:Decision Making; D004504:Education, Medical, Undergraduate / Q000379:methods; D019317:Evidence-Based Medicine; D006801:Humans; D007087:Illinois; D016544:Patient Simulation; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D015203:Reproducibility of Results; D013337:Students, Medical; D014911:Whiplash Injuries / Q000628:therapy