Kunz Regina, Wegscheider Karl, Fritsche Lutz, Schünemann Holger J, Moyer Virginia, Miller Donald, Boluyt Nicole, Falck-Ytter Yngve, Griffiths Peter, Bucher Heiner C, Timmer Antje, Meyerrose Jana, Witt Klaus, Dawes Martin, Greenhalgh Trisha, Guyatt Gordon H
Open Med. 2010;4(1):e3-e10. doi: 10.2174/1874104501004010003. Epub 2010 Jan 5.
Health care professionals worldwide attend courses and workshops to learn evidence-based medicine (EBM), but evidence regarding the impact of these educational interventions is conflicting and of low methodologic quality and lacks generalizability. Furthermore, little is known about determinants of success. We sought to measure the effect of EBM short courses and workshops on knowledge and to identify course and learner characteristics associated with knowledge acquisition.
Health care professionals with varying expertise in EBM participated in an international, multicentre before-after study. The intervention consisted of short courses and workshops on EBM offered in diverse settings, formats and intensities. The primary outcome measure was the score on the Berlin Questionnaire, a validated instrument measuring EBM knowledge that the participants completed before and after the course.
A total of 15 centres participated in the study and 420 learners from North America and Europe completed the study. The baseline score across courses was 7.49 points (range 3.97-10.42 points) out of a possible 15 points. The average increase in score was 1.40 points (95% confidence interval 0.48-2.31 points), which corresponded with an effect size of 0.44 standard deviation units. Greater improvement in scores was associated (in order of greatest to least magnitude) with active participation required of the learners, a separate statistics session, fewer topics, less teaching time, fewer learners per tutor, larger overall course size and smaller group size. Clinicians and learners involved in medical publishing improved their score more than other types of learners; administrators and public health professionals improved their score less. Learners who perceived themselves to have an advanced knowledge of EBM and had prior experience as an EBM tutor also showed greater improvement than those who did not.
EBM course organizers who wish to optimize knowledge gain should require learners to actively participate in the course and should consider focusing on a small number of topics, giving particular attention to statistical concepts.
世界各地的医疗保健专业人员参加课程和研讨会以学习循证医学（EBM），但关于这些教育干预措施影响的证据相互矛盾，方法学质量较低且缺乏普遍性。此外，对于成功的决定因素知之甚少。我们试图衡量循证医学短期课程和研讨会对知识的影响，并确定与知识获取相关的课程和学习者特征。
具有不同循证医学专业知识的医疗保健专业人员参与了一项国际性、多中心的前后对照研究。干预措施包括在不同环境、形式和强度下提供的循证医学短期课程和研讨会。主要结局指标是柏林问卷的得分，这是一种经过验证的衡量循证医学知识的工具，参与者在课程前后均需完成该问卷。
共有15个中心参与了该研究，来自北美和欧洲的420名学习者完成了研究。各课程的基线得分在满分15分中为7.49分（范围为3.97 - 10.42分）。得分的平均增加为1.40分（95%置信区间为0.48 - 2.31分），这相当于效应大小为0.44个标准差单位。得分的更大提高与（按影响程度从大到小排序）要求学习者积极参与、单独的统计学课程、较少的主题、较少的教学时间、每位导师指导的学习者较少、总体课程规模较大以及小组规模较小相关。参与医学出版的临床医生和学习者得分提高幅度大于其他类型的学习者；管理人员和公共卫生专业人员得分提高幅度较小。自认为具有循证医学高级知识且有循证医学导师经验的学习者得分提高幅度也大于没有这些情况的学习者。
希望优化知识获取的循证医学课程组织者应要求学习者积极参与课程，并应考虑专注于少数主题，尤其要关注统计学概念。
