学习循证医学的挑战及应对这些挑战的教育方法：对美国和加拿大医学院部分循证医学课程的定性研究

Challenges to Learning Evidence-Based Medicine and Educational Approaches to Meet These Challenges: A Qualitative Study of Selected EBM Curricula in U.S. and Canadian Medical Schools.

作者信息

Maggio Lauren A, ten Cate Olle, Chen H Carrie, Irby David M, O'Brien Bridget C

机构信息

L.A. Maggio is director of research and instruction, Lane Medical Library, Stanford University School of Medicine, Stanford, California, and a doctoral student in health professions education in the joint doctoral program, University of California, San Francisco, San Francisco, California, and University Medical Center Utrecht, Utrecht, the Netherlands. O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. H.C. Chen is professor of pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. D.M. Irby is professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. B.C. O'Brien is associate professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

出版信息

Acad Med. 2016 Jan;91(1):101-6. doi: 10.1097/ACM.0000000000000814.

DOI:10.1097/ACM.0000000000000814

PMID:26200580

Abstract

PURPOSE

Evidence-based medicine (EBM) is a fixture in many medical school curricula. Yet, little is known about the challenges medical students face in learning EBM or the educational approaches that medical schools use to overcome these challenges.

METHOD

A qualitative multi-institutional case study was conducted between December 2013 and July 2014. On the basis of the Association of American Medical Colleges 2012 Medical School Graduation Questionnaire data, the authors selected 22 U.S. and Canadian Liaison Committee on Medical Education-accredited medical schools with graduates reporting confidence in their EBM skills. Participants were interviewed and asked to submit EBM curricular materials. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach.

RESULTS

Thirty-one EBM instructors (17 clinicians, 11 librarians, 2 educationalists, and 1 epidemiologist) were interviewed from 17 medical schools (13 in the United States, 4 in Canada). Four common EBM learning challenges were identified: suboptimal role models, students' lack of willingness to admit uncertainty, a lack of clinical context, and students' difficulty mastering EBM skills. Five educational approaches to these challenges that were common across the participating institutions were identified: integrating EBM with other courses and content, incorporating clinical content into EBM training, EBM faculty development, EBM whole-task exercises, and longitudinal integration of EBM.

CONCLUSIONS

The identification of these four learner-centered EBM challenges expands on the literature on challenges in teaching and practicing EBM, and the identification of these five educational approaches provides medical educators with potential strategies to inform the design of EBM curricula.

摘要

目的

循证医学（EBM）是许多医学院校课程中的固定内容。然而，对于医学生在学习循证医学时面临的挑战，或者医学院校用来克服这些挑战的教育方法，我们知之甚少。

方法

2013年12月至2014年7月进行了一项多机构定性案例研究。根据美国医学院协会2012年医学院毕业调查问卷数据，作者选择了22所经美国和加拿大医学教育联络委员会认证的医学院校，这些院校的毕业生对其循证医学技能表示有信心。对参与者进行了访谈，并要求他们提交循证医学课程材料。访谈进行了录音、转录，并采用归纳法进行分析。

结果

来自17所医学院校（美国13所，加拿大4所）的31名循证医学教师（17名临床医生、11名图书馆员、2名教育学家和1名流行病学家）接受了访谈。确定了四个常见的循证医学学习挑战：榜样不佳、学生不愿承认不确定性、缺乏临床背景以及学生难以掌握循证医学技能。确定了参与机构普遍采用的应对这些挑战的五种教育方法：将循证医学与其他课程和内容相结合、将临床内容纳入循证医学培训、循证医学教师发展、循证医学全任务练习以及循证医学的纵向整合。