Young Taryn, Rohwer Anke, Volmink Jimmy, Clarke Mike
Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa ; South African Cochrane Centre, South African Medical Research Council, Cape Town, South Africa ; Community Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
PLoS One. 2014 Jan 28;9(1):e86706. doi: 10.1371/journal.pone.0086706. eCollection 2014.
An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners. This overview systematically evaluated and organized evidence from systematic reviews on teaching evidence-based health care (EBHC).
METHODS/FINDINGS: We searched for systematic reviews evaluating interventions for teaching EBHC to health professionals compared to no intervention or different strategies. Outcomes covered EBHC knowledge, skills, attitudes, practices and health outcomes. Comprehensive searches were conducted in April 2013. Two reviewers independently selected eligible reviews, extracted data and evaluated methodological quality. We included 16 systematic reviews, published between 1993 and 2013. There was considerable overlap across reviews. We found that 171 source studies included in the reviews related to 81 separate studies, of which 37 are in more than one review. Studies used various methodologies to evaluate educational interventions of varying content, format and duration in undergraduates, interns, residents and practicing health professionals. The evidence in the reviews showed that multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes. Interventions improved critical appraisal skills and integration of results into decisions, and improved knowledge, skills, attitudes and behaviour amongst practicing health professionals. Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching. Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behavior, but not appraisal skills. EBHC courses improved appraisal skills and knowledge. Amongst practicing health professionals, interactive online courses with guided critical appraisal showed significant increase in knowledge and appraisal skills. A short workshop using problem-based approaches, compared to no intervention, increased knowledge but not appraisal skills.
EBHC teaching and learning strategies should focus on implementing multifaceted, clinically integrated approaches with assessment. Future rigorous research should evaluate minimum components for multifaceted interventions, assessment of medium to long-term outcomes, and implementation of these interventions.
循证医疗保健方法在国际上被公认为是医疗保健从业者的一项关键能力。本综述系统地评估并整理了关于循证医疗保健教学（EBHC）的系统评价中的证据。
方法/结果：我们检索了评估向卫生专业人员传授EBHC的干预措施的系统评价，与无干预措施或不同策略进行比较。结果涵盖EBHC知识、技能、态度、实践和健康结果。于2013年4月进行了全面检索。两名评审员独立选择符合条件的综述，提取数据并评估方法学质量。我们纳入了1993年至2013年间发表的16篇系统评价。各综述之间存在相当多的重叠。我们发现，综述中包含的171项原始研究与81项独立研究相关，其中37项研究在不止一篇综述中出现。研究采用了各种方法来评估针对本科生、实习生、住院医师和执业卫生专业人员的内容、形式和时长各异的教育干预措施。综述中的证据表明，多方面的、临床整合的、带有评估的干预措施可带来知识、技能和态度的改善。干预措施提高了批判性评价技能以及将结果整合到决策中的能力，并改善了执业卫生专业人员的知识、技能、态度和行为。考虑单一干预措施时，基于讲座的教学与在线教学在EBHC知识和态度方面相似。期刊俱乐部似乎增加了临床流行病学和生物统计学知识以及阅读行为，但未提高评价技能。EBHC课程提高了评价技能和知识。在执业卫生专业人员中，带有引导性批判性评价的交互式在线课程显示知识和评价技能有显著提高。与无干预措施相比，采用基于问题的方法的短期工作坊增加了知识，但未提高评价技能。
EBHC的教学策略应侧重于实施多方面的、临床整合的、带有评估的方法。未来严谨的研究应评估多方面干预措施的最小组成部分、中长期结果的评估以及这些干预措施的实施情况。
