title: Senior internal medicine residents' confidence with essential topics in evidence-based medicine taught during internship.
abstract: BACKGROUND
  Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics.
  
  
  OBJECTIVE
  To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum.
  
  
  METHODS
  All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents.
  
  
  RESULTS
  Forty-five PGY-3 (88%; n  =  51) and 42 PGY-1 (91%; n  =  46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P  =  .002), number needed to harm (mean difference, 1.09; P  =  .002), likelihood ratio (mean difference, 1.01; P  =  .003), formulation of a focused clinical question (mean difference, 0.98; P  =  .001), and critical appraisal of therapy articles (mean difference, 0.91; P  =  .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, -0.86; P  =  .002), study design for prognosis questions (mean difference, -0.75; P  =  .004), number needed to harm (mean difference, -0.67; P  =  .01), ability to critically appraise systematic reviews (mean difference, -0.65, P  =  .009), and retrieval of evidence (mean difference, -0.56; P  =  .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics.
  
  
  CONCLUSIONS
  Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency 5 help reinforce residents' EBM knowledge and their confidence.
authors.forename: Mira T
authors.initials: MT
authors.lastname: Keddis
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Beckman
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cullen
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Reed
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Halvorsen
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Wittich
authors.forename: Colin P
authors.initials: CP
authors.lastname: West
authors.forename: Furman S
authors.initials: FS
authors.lastname: McDonald