Can ‘Evidence Based Practice’ be Taught in a way that is Meaningful to the Student for Practice?

Summary

Increasingly, it is expected that graduates from a wide range of disciplines will have the necessary skills and knowledge to practice within their chosen field according to evidence based practice (EBP) guidelines. The best methods to facilitate this process have not been fully evaluated. In this paper we describe our journey from problem identification to introduction of a curriculum change to address the academic–clinical divide in EBP skill development. Preliminary results suggest favourable outcomes including improved student confidence in the integration of EBP in practice and clinical educators’ knowledge, and value of EBP on clinical placement.

Keywords:

• critically appraised topics
• EBP implementation
• clinical practice
• undergraduate
• curriculum

Introduction

Increasingly, it is expected that graduates from a wide range of disciplines will have the necessary skills and knowledge to practise within their chosen field according to evidence based practice (EBP) guidelines. However, the best methods to facilitate this process have not been fully evaluated. Studies have demonstrated that the teaching of EBP can be challenging in relation to changing student behaviours (Del Mar et al. 2004) and integrating into practice (Coomarasamy & Khan 2004).

A review of EBP teaching within the curriculum at the University of Nottingham Division of Physiotherapy Education demonstrated that the staff and students felt that the course and teaching were separated from practice, and as such EBP skills and knowledge were not translated into clinical practice. This fundamental separation of theoretical teaching and practice posed a number of questions:

1. Can the teaching of EBP better integrate classroom taught skills and knowledge into the context of the clinical environment?

2. What are the potential facilitators and barriers to the introduction of new teaching methods within this field?

Methods

A mixed methods action research was developed to assess and analyse the effects of the introduction of a new teaching strategy for EPB teaching based on the proposals from the Centre for Evidence Based Practice (CEBM) (Jackson et al. 2006, CEBM tools and resources, 2013) and BestBETS (2013).

Preliminary findings

The views of key stakeholders were questioned regarding their EBP use and application within the clinical environment and teaching. Clinical educators’ focus groups demonstrated the following key themes:

1. Inconsistency in application of EBP skills by students on clinical placement.

2. A lack of value attributed to EBP skills on placement.

3. A lack of confidence in clinical educators’ own EBP skills to make judgements on the quality of students’ work.

4. Time as the main limiting factor to EBP making ‘EBP take a backseat to the frontline delivery of care’.

Second year students completed a survey before the module commenced. The survey was based on one developed and modified from a previous study investigating the effects of curricula change on student learning. It therefore had demonstrated face validity. Although short (seven statements with a nine-point Likert scale strongly agree to strongly disagree) it sampled students’ perceptions of confidence in their knowledge base, skills and ability to clinically utilise both when embarking on forthcoming placements. Responses demonstrated overall low to moderate confidence in students’ ability to use and effectively apply EBP skills and knowledge within the clinical environment.

New teaching approach introduction

The second year of the academic curriculum introduced an EBP practical skill tools approach drawn from the CEBM and BestBETs work (BestBETS 2013, CEBM tools and resources 2013). Introductory pre-implementation sessions for clinical educator familiarisation were undertaken to address the key barriers and questions identified from the focus groups. During the four clinical placements over the year students undertook a critically appraised topic CAT presentation with formative assessment by the clinical team; providing feedback to peers on their return to class-based activities. This revolving academic–clinical environment expectation of EBP skill implementation aimed to address the perceived academic–clinical divide and to provide on-going up-skilling for all stakeholders.

Preliminary results suggest favourable outcomes including improved student confidence in the integration of EBP in practice and clinical educators’ knowledge and value of EBP on clinical placement. Further feedback from students, clinical educators and staff, as well as on-going assessment of the impact of the new teaching methods on student outcomes is planned.