Appraising and applying evidence about a diagnostic test during a performance-based assessment.
BACKGROUND
The practice of Evidence-based Medicine requires that clinicians assess the validity of published research and then apply the results to patient care. We wanted to assess whether our soon-to-graduate medical students could appraise and apply research about a diagnostic test within a clinical context and to compare our students with peers trained at other institutions.


METHODS
4th year medical students who previously had demonstrated competency at probability revision and just starting first-year Internal Medicine residents were used for this research. Following an encounter with a simulated patient, subjects critically appraised a paper about an applicable diagnostic test and revised the patient's pretest probability given the test result.


RESULTS
The medical students and residents demonstrated similar skills at critical appraisal, correctly answering 4.7 and 4.9, respectively, of 6 questions (p = 0.67). Only one out of 28 (3%) medical students and none of the 15 residents were able to correctly complete the probability revision task (p = 1.00).


CONCLUSIONS
This study found that most students completing medical school are able to appraise an article about a diagnostic test but few are able to apply the information from the article to a patient. These findings raise questions about the clinical usefulness of the EBM skills possessed by graduating medical students within the area of diagnostic testing.
Department of Family Medicine, The University of Iowa, Iowa City 52242, USA. george-bergus@uiowa.edu
George
G
Bergus
Scott
S
Vogelgesang
Janeta
J
Tansey
Ellen
E
Franklin
Ronald
R
Feld
D001499:Bayes Theorem; D002982:Clinical Clerkship / Q000592:standards; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003865:Major Depressive Disorder / Q000175:diagnosis; D004504:Education, Medical, Undergraduate / Q000379:methods*; D019317:Evidence-Based Medicine / Q000193:education* / Q000706:statistics & numerical data; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards; D007484:Iowa; D016584:Panic Disorder / Q000175:diagnosis; D005791:Patient Care; D016544:Patient Simulation; D011237:Predictive Value of Tests; D011570:Psychiatry / Q000193:education*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity