title: An evidence-based medicine curriculum implemented in journal club improves resident performance on the Fresno test.
abstract: BACKGROUND
  Journal club is a standard component of residency education. Journal club focuses on review and interpretation of the medical literature with varying degrees of evidence-based medicine (EBM) education.
  
  
  OBJECTIVE
  To evaluate learning of EBM principles with an EBM curriculum implemented as a component of journal club. EBM competency was established using the Fresno test, a validated 12-question instrument of short-answer and essay-style questions to assess competency in EBM.
  
  
  METHODS
  An EBM curriculum was implemented that consisted of a focus on EBM topics (e.g., study validity, bias, confidence intervals, search strategies) using a structured journal club format using a peer instruction model. The Fresno test was used prior to and after the implementation of the first year of this curriculum to measure effectiveness of the intervention. A hierarchical multivariable model using generalized estimating equations was used to account for repeated measures in the primary outcome of change in total Fresno test score.
  
  
  RESULTS
  The total test scores did not increase significantly (105.4 vs. 120.9, p = 0.058) in the before-after analysis. The only subscore showing improvement was interpretation of study validity (32.1 vs. 40.4 points, p = 0.03). Attendance was significantly associated with Fresno test score, with those attending ≥ 6/11 sessions (55%) scoring 28.2 points higher (p = 0.003), and those attending fewer than six sessions scoring only 1.9 points higher (p = 0.81) than in the preintervention group.
  
  
  CONCLUSIONS
  An EBM curriculum implemented as part of journal club improves performance on the Fresno test among residents who attended at least six journal club sessions.
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Stoltze
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Iowa Injury Prevention Center, University of Iowa College of Public Health, Iowa City, Iowa.
authors.forename: Karisa K
authors.initials: KK
authors.lastname: Harland
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Jon N
authors.initials: JN
authors.lastname: Van Heukelom
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Hogrefe
authors.affiliation: Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Azeemuddin
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods; D004635:Emergency Medicine / Q000193:education*; D019317:Evidence-Based Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007484:Iowa
keywords: Fresno test; education; educational measurement; evidence-based medicine; internship and residency; medical