Shaughnessy Allen F, Gupta Priya S, Erlich Deborah R, Slawson David C
Department of Family Medicine, Tufts University, Malden, MA, USA.
Fam Med. 2012 Apr;44(4):259-64.
Teaching evidence-based medicine is becoming more frequent in family medicine residency education, as is the teaching of information mastery, which is using techniques to answer clinical questions at the point of care and to keep up with changes in medical knowledge. The goal of this study was to determine the effect of an integrated curriculum of information mastery on residents' evidence-based medicine knowledge and skills as well as their confidence at critically appraising medical literature and using evidence to inform clinical decisions.
We used a before-after study in a single residency over 5 years. Residents completed the Fresno Test of Evidence-based Medicine and an attitude questionnaire at the start of the curriculum and then again before graduation. The integrated curriculum consisted of intensive instruction over the course of 1 month (30 hours), followed by a longitudinal series of ongoing conferences, integrated into the teaching of clinical content. Teaching was also integrated into day-to-day clinical activities via precepting interactions.
Twenty-three residents completed the study. Modified Fresno Test scores significantly improved from 104.0 to 121.5. Using a pass/fail approach, nine residents (40.1%) passed the test at the start of training, increasing to 17 (73.4%) at the end of the intervention. Confidence in critical appraisal scores increased from an average 17.90 (95% CI=16.55--19.25) to 21.10 (95% CI=19.49--22.71), out of a possible score of 25. Confidence scores were significantly lower in residents who did not pass the posttest (18.5 versus 21.9). Attitudes regarding confidence in the use of evidence and a decreased reliance on experts were also improved following the curriculum.
A curriculum of information mastery, integrated across the greater curriculum, improved trainees' evidence-based medicine knowledge and skills and attitude toward using evidence to inform clinical decision making.
循证医学教学在家庭医学住院医师培训教育中越来越常见，信息掌握教学亦是如此，信息掌握是指运用技巧在医疗现场回答临床问题并跟上医学知识的更新。本研究的目的是确定信息掌握综合课程对住院医师循证医学知识与技能的影响，以及他们在批判性评价医学文献和运用证据指导临床决策方面的信心。
我们在一个住院医师培训项目中进行了为期5年的前后对照研究。住院医师在课程开始时以及毕业前分别完成了弗雷斯诺循证医学测试和一份态度问卷。综合课程包括为期1个月（30小时）的强化教学，随后是一系列贯穿始终的会议，并融入临床内容教学中。教学还通过带教互动融入日常临床活动。
23名住院医师完成了研究。改良后的弗雷斯诺测试分数从104.0显著提高到121.5。采用及格/不及格评定法，9名住院医师（40.1%）在培训开始时通过测试，干预结束时增至17名（73.4%）。批判性评价分数的信心从平均17.90（95%CI=16.55-19.25）提高到21.10（95%CI=19.49-22.71），满分25分。未通过后期测试的住院医师信心分数显著更低（18.5比21.9）。课程结束后，住院医师在运用证据的信心以及减少对专家的依赖方面的态度也有所改善。
融入整个课程体系的信息掌握课程，提高了学员的循证医学知识与技能，以及运用证据指导临床决策的态度。
