Luciano Gina L, Visintainer Paul F, Kleppel Reva, Rothberg Michael B
From the Baystate Medical Center, Springfield, Massachusetts, and the Cleveland Clinic, Cleveland, Ohio.
South Med J. 2016 Feb;109(2):108-11. doi: 10.14423/SMJ.0000000000000408.
Evidence-based medicine (EBM) skills are important to daily practice, but residents generally feel unskilled incorporating EBM into practice. The Kolb experiential learning theory, as applied to curricular planning, offers a unique methodology to help learners build an EBM skill set based on clinical experiences. We sought to blend the learner-centered, case-based merits of the morning report with an experientially based EBM curriculum. We describe and evaluate a patient-centered ambulatory morning report combining the User's Guides to the Medical Literature approach to EBM and experiential learning theory in the internal medicine department at Baystate Medical Center.
The Kolb experiential learning theory postulates that experience transforms knowledge; within that premise we designed a curriculum to build EBM skills incorporating residents' patient encounters. By developing structured clinical questions based on recent clinical problems, residents activate prior knowledge. Residents acquire new knowledge through selection and evaluation of an article that addresses the structured clinical questions. Residents then apply and use new knowledge in future patient encounters.
To assess the curriculum, we designed an 18-question EBM test, which addressed applied knowledge and EBM skills based on the User's Guides approach. Of the 66 residents who could participate in the curriculum, 61 (92%) completed the test. There was a modest improvement in EBM knowledge, primarily during the first year of training.
Our experiential curriculum teaches EBM skills essential to clinical practice. The curriculum differs from traditional EBM curricula in that ours blends experiential learning with an EBM skill set; learners use new knowledge in real time.
循证医学（EBM）技能对日常临床实践很重要，但住院医师普遍觉得自己缺乏将循证医学融入实践的技能。应用于课程规划的科尔布体验式学习理论提供了一种独特的方法，可帮助学习者基于临床经验构建循证医学技能集。我们试图将以学习者为中心、基于病例的早交班优点与基于体验的循证医学课程相结合。我们描述并评估了贝斯州医疗中心内科一种以患者为中心的门诊早交班，该交班结合了《医学文献用户指南》中循证医学的方法和体验式学习理论。
科尔布体验式学习理论假定经验能转化知识；在此前提下，我们设计了一门课程，以结合住院医师的患者诊疗经历来培养循证医学技能。通过根据近期临床问题提出结构化临床问题，住院医师激活已有的知识。住院医师通过筛选和评估一篇针对结构化临床问题的文章来获取新知识。然后，住院医师在未来的患者诊疗中应用并运用新知识。
为评估该课程，我们设计了一项包含18个问题的循证医学测试，该测试基于《用户指南》方法考查应用知识和循证医学技能。在66名可参与该课程的住院医师中，61名（92%）完成了测试。循证医学知识有适度提高，主要是在培训的第一年。
我们的体验式课程教授临床实践所需的循证医学技能。该课程与传统循证医学课程的不同之处在于，我们将体验式学习与循证医学技能集相结合；学习者能实时运用新知识。
