Nicholson Laura J, Shieh Lisa Y
University of California, School of Medicine, San Diego, USA.
Acad Med. 2005 Jun;80(6):607-9. doi: 10.1097/00001888-200506000-00018.
To increase evidence-based medicine (EBM) instruction within the confines of reduced resident work hours.
In 2001-02, the authors designed and implemented an EBM curriculum for residents on an inpatient medicine service at Stanford University Medical Center. Thirty-six residents were assigned the hospitalist rotation in its pilot year. Attendings introduced EBM concepts and Internet resources. During daily rounds, housestaff presented patient-based EBM literature search results. After the rotation, residents were given a questionnaire on which they were asked to rate the impact of the curriculum on their understanding of 20 EBM terms or practice skills (1 = no effect to 5 = strong effect).
Twenty-three residents (64%) completed the questionnaire. The results were very positive with average effect of more than 4 (somewhat strong effect/impact) for 16 of the 20 questions. High-speed Internet access and EBM Web resources were critical to efficient delivery of the curriculum during inpatient care.
The pilot curriculum successfully introduced the practice of EBM during active inpatient care without requiring additional hours from housestaff schedules. To further evaluate and expand this project, EBM skills will be tested before and after the rotation, and faculty development will allow consistent delivery in additional clinical settings.
在住院医师工作时长减少的情况下，增加循证医学（EBM）教学。
2001 - 2002年，作者为斯坦福大学医学中心内科住院部的住院医师设计并实施了一门循证医学课程。在试点年份，36名住院医师被安排参与医院医师轮转。主治医生介绍循证医学概念和网络资源。在日常查房期间，住院医生展示基于患者的循证医学文献检索结果。轮转结束后，向住院医师发放问卷，要求他们对该课程对其理解20个循证医学术语或实践技能的影响进行评分（1 = 无影响至5 = 影响强烈）。
23名住院医师（64%）完成了问卷。结果非常积极，20个问题中有16个的平均影响超过4（有些影响强烈）。高速网络接入和循证医学网络资源对于在住院治疗期间高效开展该课程至关重要。
该试点课程在住院医师实际进行住院治疗期间成功引入了循证医学实践，且无需住院医生增加工作时长。为了进一步评估和扩展该项目，将在轮转前后测试循证医学技能，并且教师培训将使该课程能够在更多临床环境中持续开展。
