Feasibility and Impact of a Novel, Multifaceted and Clinically Integrated Evidence-Based Medicine Curriculum in two UK Undergraduate Medical Schools

Background

There is a need to develop, assess and disseminate effective approaches to Evidence-Based Medicine (EBM) teaching in undergraduate medical education. The aim of this thesis was to design and deliver a multifaceted, clinically integrated EBM curriculum and to evaluate its feasibility and impact in two UK medical schools.

Methods

To address research questions related to the overall aim of the thesis, the following work packages were undertaken:

a) A systematic review was carried out to identify validated tools to evaluate EBM teaching.

b) After redesigning EBM teaching, the Fresno test was used as a progress test in years one and two to evaluate the effectiveness of EBM teaching.

c) Two approaches to delivering EBM teaching (face-to-face vs online) were tested during years three and four of the MB ChB programme. Students’ performance in Assessing Competency in EBM (ACE), Educational Prescriptions (EP), written summative examination and EBM Objective Structured Clinical Examination (OSCE) were compared for the two approaches.

d) Six EBM OSCE stations were developed with increasingly complex tasks, with an aim to establish a spiral approach for EBM assessments.

e) Medical students’ perceptions of EBM training were explored using focus groups.

Results

a) Six tools of reasonable validity for evaluating EBM teaching were identified. One of these, the Fresno test was selected for further use within this thesis.

b) Evaluation of EBM teaching demonstrated a significant increase in knowledge, the average score increased by 38.7 marks (p<0.001).

c) Students performed similarly in ACE, written assessment and the OSCEs in both approaches to teaching, while students in the face-to-face teaching approach performed better in EPs (MD=‐2.28, 95%CI: ‐4.31, ‐0.26).

d) Five of the six EBM OSCE stations had excellent correlation coefficients and a high reliability ranging from 0.21‐0.49.

a) EBM was perceived to be important by medical students during training and for future practice.

Conclusions

It was feasible to develop and implement a multifaceted, clinically integrated EBM teaching in two medical schools in UK. Evaluation of the curriculum has demonstrated a significant increase in students’ EBM knowledge. A spiral approach to assessments can provide evidence for assessing scaffolded learning and mastery of EBM competencies.