Teaching evidence-based medicine: Impact on students’ literature use and inpatient clinical documentation

Figures & data

Table

Practice points

Effective methods to teach EBM skills to medical students are paramount. A physician-led hands-on workshop teaching literature searching sills was associated with increased comfort and confidence with EBM. Students demonstrated increased use of EBM and improved incorporation of EBM into their inpatient clinical notes following the workshop.

Table 1.  Self-reported percentages of attitude outcomes among 98 students before and after a third-year EBM clerkship intervention

Survey question	Pre-workshop (percentage agree/ strongly agree)	Post-workshop (percentage agree/ strongly agree)	End of clerkship (percentage agree/ strongly agree)	p-Value
I feel comfortable using EBM to answer clinical questions	73	96	91	<0.001*
After performing a literature search, I feel confident I have found the best evidence to answer the question	30	89	75	<0.001*
EBM helps clinical decision making	89	99	94	0.010*
EBM is useful on a daily basis	80	95	91	0.031*
Literature searches are too time-consuming to do in the hospital or clinic	29	7	8	<0.001*
Questions can be more quickly answered with textbooks or consultants rather than literature searches	40	18	21	0.002*

Note: *p-Value < 0.05, Fisher's exact test.

Figure 1. Survey data of average number of times per week a literature resource was reported utilized before and after the workshop.

Table 2.  Number and type of EBM citations in clerkship notes

	Mean citations per note (95% CI)
	Pre-workshop	Post-workshop	p-Value
Total number of citations per note	2.29 (1.92–2.67)	2.15 (1.84–2.47)	0.57
Textbook citations per note	0.098 (0.04–0.16)	0.196 (0.10–0.29)	0.09
UpToDate citations per note	0.233 (0.071–0.395)	0.202 (0.105–0.301)	0.75
Journal citations per note	1.81 (1.48–2.13)	1.54 (1.27–1.81)	0.21
Guideline citations per note	0.105 (0.041–0.170)	0.123 (0.068–0.179)	0.68
Systematic Review citations per note	0.053 (0.009–0.096)	0.094 (0.041–0.148)	0.24

Notes: Numbers represent mean citations per note for 298 notes written by 51 unique students. p-Values were calculated using two-tailed t-tests.

Table 3.  Quality of EBM content in clerkship notes

	Mean quality score (95% CI)
	Pre-workshop	Post-workshop	Improvement (95% CI)	p-Value
Quality of EBM discussion and application to patient	3.62 (3.33–3.92)	3.91 (3.65–4.17)	0.29 (0.04 –0.53)	0.02*
Prioritizes problem list	4.07 (3.87–4.28)	4.25 (4.5–4.45)	0.17 (−0.05–0.41)	0.14
Formulates complete differential diagnosis	3.89 (3.66–4.11)	4.08 (3.84–4.32)	0.19 (−0.03–0.41)	0.09
Discusses likelihood of differential diagnosis and plan	3.97 (3.72–4.21)	4.17 (3.91–4.42)	0.20 (−0.02–0.41)	0.07
Overall quality	3.98 (3.74–4.22)	4.14 (3.91–4.38)	0.16 (−0.06–0.39)	0.15

Notes: Numbers represent mean physician ratings for each note's assessment and plan according to a 5-point Likert scale (1, poor; 5, excellent). p-Values were calculated using a two-tailed paired t-test. *p < 0.05.

Figure 2. Percent utilization of EBM resources and non-EBM resources as determined by computer log analysis before and after the workshop.