Evidence-based medicine: discrepancy between perceived competence and actual performance among graduating medical students

Abstract

Since at the time of graduation from medical school physicians are expected to demonstrate adequate professional competence including mastery of critical appraisal skills, we conducted a preliminary, cross-sectional, web-based study to examine the extent to which fourth year medical students in the US are competent in core areas of evidence-based medicine (EBM). Using self-assessment instruments, subjects (n = 150) were asked to demonstrate their ability to understand the practical meaning of key methodological and data analysis constructs as they relate to patient care, to rate their perceived competence in core areas of EBM and to disclose their attitudes toward critical appraisal of the literature and EBM. The mean score in our cohort was 55% suggesting that students may have knowledge gaps that interfere with their ability to critically appraise the medical literature. There was an apparent chasm between subjects’ perceived competence and their actual performance on the assessment instrument. These findings, if corroborated in larger studies, (1) suggest that better education in EBM is needed so as to avoid the possibility that patient care may inadvertently be jeopardized; and (2) cast doubt on the use of self-assessed knowledge as a proxy for actual skills with respect to EBM and medical decision-making.

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Notes on contributors

Opher Caspi

OPHER CASPI is an internist and methodologist by training. His research interests span from placebo effects to decision analysis and clinical reasoning to evidence-based medicine and meta-analysis.

Patrick Mcknight

PATRICK MCKNIGHT is a research assistant professor in the department of psychology at the University of Arizona. He is an expert in measurement theory, data analysis, and computer programming.

Lillian Kruse

LILLIAN KRUSE was a student of OC at the time of the study.

Victoria Cunningham

VICTORIA CUNNINGHAM earned her PhD in program evaluation and research methodology. Her research focuses on issues related to measurement and data analysis.

Aurelio Jose Figueredo

AURELIO JOSE FIGUEREDO is a professor of psychology and directs the program of evolutionary psychology at the University of Arizona. He is an expert in multi-causal modeling and philosophy of science.

Lee Sechrest

LEE SECHREST is a world renowned expert in program evaluation, research methodology and data analysis. He has served as mentor to all other authors at different stages of their careers.