Smith C A, Ganschow P S, Reilly B M, Evans A T, McNutt R A, Osei A, Saquib M, Surabhi S, Yadav S
Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Ill. 60612, USA.
J Gen Intern Med. 2000 Oct;15(10):710-5. doi: 10.1046/j.1525-1497.2000.91026.x.
To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal.
Firm-based, controlled trial.
Urban public hospital.
Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group.
An EBM course, taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills.
The main outcome measure was performance on an EBM skills test that was administered four times over 11 months: at baseline and at three time points postcourse. Postcourse test 1 assessed the effectiveness of the intervention in the experimental group (primary outcome]; postcourse test 2 assessed the control group after it crossed over to receive the intervention; and postcourse test 3 assessed durability. Baseline EBM skills were similar in the two groups. After receiving the EBM course, the experimental group achieved significantly higher postcourse test scores (adjusted mean difference, 21%; 95% confidence interval, 13% to 28%; P < .001). Postcourse improvements were noted in three of the four EBM skill domains (formulating questions, searching, and quantitative understanding [P < .005 for all], but not in critical appraisal skills [P = .4]). After crossing over to receive the educational intervention, the control group achieved similar improvements. Both groups sustained these improvements over 6 to 9 months of follow-up.
A brief structured educational intervention produced substantial and durable improvements in residents' cognitive and technical EBM skills.
评估一项教育干预措施的效果，该措施旨在教授住院医师四项循证医学（EBM）基本技能：问题构建、文献检索、理解定量结果和批判性评价。
基于机构的对照试验。
城市公立医院。
55名内科一年级住院医师，其中18名在试验组，37名在对照组。
一门循证医学课程，由资深教员和住院总医师连续7周每周授课2小时，重点讲授四项循证医学基本技能。
主要测量指标是在11个月内进行4次的循证医学技能测试的成绩，测试时间点分别为基线期和课程结束后的3个时间点。课程结束后测试1评估试验组干预措施的效果（主要结果）；课程结束后测试2在对照组接受干预措施后进行评估；课程结束后测试3评估效果的持续性。两组的基线循证医学技能相似。接受循证医学课程后，试验组课程结束后的测试成绩显著更高（调整后平均差异为21%；95%置信区间为13%至28%；P<0.001）。四项循证医学技能领域中的三项（问题构建、检索和定量理解，各项P<0.005）在课程结束后有改善，但批判性评价技能无改善（P=0.4）。对照组在接受教育干预措施后也有类似改善。两组在6至9个月的随访期内均维持了这些改善。
一项简短的结构化教育干预措施使住院医师的认知和技术循证医学技能得到了显著且持久的改善。
