title: A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine.
abstract: BACKGROUND
  Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.
  
  
  METHODS
  A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the 'Assessing Competency in EBM' (ACE) tool. Students' self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.
  
  
  RESULTS
  A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=-0.68, (95% CI-1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.
  
  
  CONCLUSIONS
  BL is no more effective than DL at increasing medical students' knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.
authors.affiliation: Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia. dragan.ilic@monash.edu.
authors.forename: Dragan
authors.initials: D
authors.lastname: Ilic
authors.affiliation: Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Johor Bahru, Malaysia. rusli.nordin@monash.edu.
authors.forename: Rusli Bin
authors.initials: RB
authors.lastname: Nordin
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University, Robina, Australia. pglaszio@bond.edu.au.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.affiliation: Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA. tilson@usc.edu.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Tilson
authors.affiliation: Gippsland Medical School, Monash University, Churchill, Australia. elmer.villanueva@monash.edu.
authors.forename: Elmer
authors.initials: E
authors.lastname: Villanueva
mesh_terms: D000704:Analysis of Variance; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007858:Learning; D008297:Male; D018709:Statistics, Nonparametric; D013337:Students, Medical / Q000706:statistics & numerical data; D013663:Teaching / Q000379:methods*; D055815:Young Adult