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实施循证医学(EBM):对医学生全任务EBM作业的描述性分析

Practising evidence-based medicine (EBM): a descriptive analysis of medical students' whole-task EBM assignments.

作者信息

Maggio Lauren A, Capdarest-Arest Nicole

机构信息

Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Lane Medical Library, Stanford University School of Medicine, Stanford, California, USA.

出版信息

Evid Based Med. 2017 Apr;22(2):41-44. doi: 10.1136/ebmed-2016-110593. Epub 2017 Feb 6.

DOI:10.1136/ebmed-2016-110593
PMID:28167494
Abstract

Researchers have suggested whole-task learning activities to practice and teach evidence-based medicine (EBM); however, limited description exists of their use in EBM curricula. This article describes medical students' execution of a whole-task EBM assignment and characterises themes emerging from assignment submissions. Between 2013 and 2015, Stanford University's paediatric clerkship students completed a whole-task EBM assignment based on a patient encounter. The assignment captured students' efforts to perform all EBM steps and describe their patient scenario and future knowledge needs strategies. Assignments were analysed using descriptive statistics and qualitative description. 123 students completed the assignment. Students formulated therapy (n=76), prognosis (n=18), diagnosis (n=15), harm (n=9) and aetiology (n=2) questions, and used a single (n=58) or multiple information resources (n=57). Based on evidence appraisal, 95 students indicated that the found evidence would inform future practice while 16 were sceptical of its conclusivity. 65 learners wanted to share evidence with colleagues; 33 with patients and families. To meet future knowledge needs, learners suggested using a structured approach (eg, PICO (patient, intervention, comparison and outcome); n=58), reading more primary literature (n=22) and creating question logs (n=21). This article provides a glimpse into students' EBM process and demonstrates the feasibility of whole-task activities for use in EBM training. Findings related to students' clinical uncertainty and information sharing raise questions about coverage of these topics in current EBM training and suggest that further investigation is warranted.

摘要

研究人员提出了全任务学习活动来实践和教授循证医学(EBM);然而,关于其在循证医学课程中的应用描述有限。本文描述了医学生执行全任务循证医学作业的情况,并对作业提交中出现的主题进行了特征分析。2013年至2015年期间,斯坦福大学儿科实习学生基于一次患者诊疗经历完成了一项全任务循证医学作业。该作业记录了学生们执行所有循证医学步骤的努力,以及他们对患者情况和未来知识需求策略的描述。使用描述性统计和定性描述对作业进行了分析。123名学生完成了作业。学生们提出了治疗(n = 76)、预后(n = 18)、诊断(n = 15)、危害(n = 9)和病因(n = 2)问题,并使用了单一(n = 58)或多种信息资源(n = 57)。基于证据评估,有95名学生表示所发现的证据将为未来的实践提供参考,而16名学生对其结论性表示怀疑。65名学习者希望与同事分享证据;33名希望与患者及家属分享。为满足未来的知识需求,学习者建议采用结构化方法(如PICO(患者、干预措施、对照和结局);n = 58)、阅读更多的原始文献(n = 22)以及创建问题日志(n = 21)。本文简要介绍了学生的循证医学过程,并证明了全任务活动在循证医学培训中的可行性。与学生临床不确定性和信息共享相关的研究结果引发了对当前循证医学培训中这些主题覆盖范围的质疑,并表明有必要进行进一步调查。

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