Thor Johan, Olsson Daniel, Nordenström Jörgen
The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, P O Box 1026, SE-551 11, Jönköping, Sweden.
The Medical Management Centre, Department for Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 5th floor, SE-171 77, Stockholm, Sweden.
BMC Med Educ. 2016 Mar 8;16:86. doi: 10.1186/s12909-016-0601-9.
Many doctors fail to practice Evidence-Based Medicine (EBM) effectively, in part due to insufficient training. We report on the design, fate and impact of a short learner-centered EBM train-the-trainer program aimed at all 2400 doctors at the Karolinska University Hospital in Sweden on the heels of a tumultuous merger, focusing particularly on whether it affected the doctors' knowledge, attitudes and skills regarding EBM.
We used a validated EBM instrument in a before-and-after design to assess the impact of the training. Changes in responses were analyzed at the individual level using the Wilcoxon matched pairs test. We also reviewed documentation from the program - including the modular EBM training schedule and the template for participants' Critically Appraised Topic reports - to describe the training's content, design, conduct, and fate.
The training, designed to be delivered in modules of 45 min totaling 1.5 days, failed to reach most doctors at the hospital, due to cost cutting pressures and competing demands. Among study participants (n = 174), many reported suboptimal EBM knowledge and skills before the training. Respondents' strategies for solving clinical problems changed after the training: the proportion of respondents reporting to use (or intend to use) secondary sources "Often/very often" changed from 5 % before the training to 76 % after the training; in parallel, reliance on textbooks and on colleagues fell (48 to 23 % and 79 to 65 %, respectively). Participants' confidence in assessing scientific articles increased and their attitudes toward EBM became more positive. The proportion of correct answers in the EBM knowledge test increased from 52 to 71 %. All these changes were statistically significant at p < 0.05.
Many study participants, despite working at a university hospital, lacked basic EBM knowledge and skills and used the scientific literature suboptimally. The kind of short learner-centered EBM training evaluated here brought significant improvements among the minority of hospital doctors who were able to participate and, if applied widely, could contribute to better, safer and more cost-effective care.
许多医生未能有效地践行循证医学（EBM），部分原因是培训不足。我们报告了一个以学习者为中心的简短循证医学培训师培训项目的设计、实施情况及影响。该项目面向瑞典卡罗林斯卡大学医院的全体2400名医生，是在一次混乱的合并之后开展的，特别关注其是否影响了医生在循证医学方面的知识、态度和技能。
我们采用经过验证的循证医学工具，通过前后对照设计来评估培训的影响。使用Wilcoxon配对检验在个体层面分析回答的变化。我们还审查了该项目的文档——包括模块化的循证医学培训时间表和参与者的批判性评价主题报告模板——以描述培训的内容、设计、实施情况及实施效果。
该培训设计为以45分钟为一个模块，总共1.5天，但由于成本削减压力和其他需求竞争，未能覆盖医院的大多数医生。在研究参与者（n = 174）中，许多人在培训前报告称循证医学知识和技能欠佳。培训后，受访者解决临床问题的策略发生了变化：报告“经常/非常经常”使用（或打算使用）二手资料的受访者比例从培训前的5%升至培训后的76%；与此同时，对教科书和同事的依赖程度下降（分别从48%降至23%和从79%降至65%）。参与者评估科学文章的信心增强，他们对循证医学的态度也变得更加积极。循证医学知识测试中的正确答案比例从52%提高到了71%。所有这些变化在p < 0.05时具有统计学意义。
许多研究参与者尽管在大学医院工作，但缺乏基本的循证医学知识和技能，对科学文献的利用也不尽如人意。此处评估的这种以学习者为中心的简短循证医学培训，使少数能够参与的医院医生有了显著进步，如果广泛应用，可能有助于提供更好、更安全且更具成本效益的医疗服务。
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