title: Using educational prescriptions to teach medical students evidence-based medicine.
abstract: OBJECTIVE
  To evaluate feasibility and impact of evidence-based medicine (EBM) educational prescriptions (EPs) in medical student clerkships.
  
  
  METHODS
  Students answered clinical questions during clerkships using EPs, which guide learners through the "four As" of EBM. Epidemiology fellows graded EPs using a rubric. Feasibility was assessed using descriptive statistics and student and fellow end-of-study questionnaires, which also measured impact. In addition, for each EP, students reported patient impact. Impact on EBM skills was assessed by change in EP scores over time and scores on an EBM objective structured clinical exam (OSCE) that were compared to controls from the prior year.
  
  
  RESULTS
  117 students completed 402 EPs evaluated by 24 fellows. Average score was 7.34/9.00 (SD 1.58). 69 students (59%) and 21 fellows (88%) completed questionnaires. Most students thought EPs improved "Acquiring" and "Appraising". Almost half thought EPs improved "Asking" and "Applying". Fellows did not value grading EPs. For 18% of EPs, students reported a "change" or "potential change" in treatment. 56% "confirmed" treatment. EP scores increased by 1.27 (95% CI: 0.81-1.72). There were no differences in OSCE scores between cohorts.
  
  
  CONCLUSIONS
  Integrating EPs into clerkships is feasible and has impact, yet OSCEs were unchanged, and research fellows had limitations as evaluators.
authors.affiliation: a Center for Evidence-based Practice , University of Pennsylvania , Philadelphia , PA , USA.|b Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA.|c Center for Clinical Epidemiology and Biostatistics , University of Pennsylvania , Philadelphia , PA , USA.|d Department of Biostatistics and Epidemiology , University of Pennsylvania , Philadelphia , PA , USA.|e Leonard Davis Institute of Health Economics , University of Pennsylvania , Philadelphia , PA , USA.|f Institute for Translational Medicine and Therapeutics , University of Pennsylvania , Philadelphia , PA , USA.|g Institute of Biomedical Informatics , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
authors.affiliation: h School of Medicine and Public Health, University of Wisconsin , Madison , WI , USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Maenner
authors.affiliation: a Center for Evidence-based Practice , University of Pennsylvania , Philadelphia , PA , USA.|b Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Mull
authors.affiliation: i School of Medicine, University of Utah , Salt Lake City , UT , USA.
authors.forename: Angela F
authors.initials: AF
authors.lastname: Veesenmeyer
authors.affiliation: c Center for Clinical Epidemiology and Biostatistics , University of Pennsylvania , Philadelphia , PA , USA.|d Department of Biostatistics and Epidemiology , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Farrar
authors.affiliation: b Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Goldfarb
authors.affiliation: b Department of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Morrison
authors.affiliation: h School of Medicine and Public Health, University of Wisconsin , Madison , WI , USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Albanese
authors.affiliation: h School of Medicine and Public Health, University of Wisconsin , Madison , WI , USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Frohna
authors.affiliation: h School of Medicine and Public Health, University of Wisconsin , Madison , WI , USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Feldstein
mesh_terms: D000328:Adult; D002982:Clinical Clerkship / Q000379:methods*; D002983:Clinical Competence; D003194:Computer-Assisted Instruction / Q000379:methods*; D003479:Curriculum; D004521:Educational Measurement; D019317:Evidence-Based Medicine / Q000193:education*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D044469:Racial Groups; D013663:Teaching