Hadvani Teena, Dutta Ankhi, Choy Eric, Kumar Shelley, Molleda Carolina, Parikh Vipul, Lopez Michelle A, Lui Karen, Ban Kathryn, Wallace Sowdhamini S
Department of Pediatrics (T Hadvani, E Choy, C Molleda, V Parikh, MA Lopez, K Lui, K Ban, and SS Wallace), Section of Pediatric Hospital Medicine, Baylor College of Medicine, Houston, Tex.
Department of Pediatrics (A Dutta), Section of Pediatric Infectious Diseases, Baylor College of Medicine, The Woodlands, Tex.
Acad Pediatr. 2021 Mar;21(2):375-383. doi: 10.1016/j.acap.2020.09.012. Epub 2020 Sep 30.
To evaluate the effectiveness of a traditional didactic session (TDS) as compared to a self-paced, interactive, multimedia module (SPM) on the application of evidence-based medicine (EBM) skills among medical students during their inpatient pediatric rotation.
We conducted a randomized controlled trial from June, 2017 to June, 2018 at a quaternary care children's hospital. Students were randomized to TDS or SPM during each 2-week block. All students completed a critical appraisal tool (CAT) of evidence related to a clinical question in a standardized appraisal form and self-reflected about the EBM process. The primary outcome was the numeric score of the CAT derived by using the validated Fresno tool. Secondary outcomes of knowledge, attitudes, confidence, and self-reported behaviors related to EBM were measured using validated surveys. Statistical analysis was performed using Student's t test for CAT scores and mixed-model procedure (PROC MIXED), with subject as random effect and time as repeated measure for the secondary outcomes.
One hundred twenty-seven clerkship students were included. Overall, there was no significant difference in mean CAT scores for TDS (n = 59) versus SPM (n = 66) groups (90.3 vs 92.0, P = .65). There were no significant differences between SPM and TDS groups for knowledge (P = .66), attitudes (P = .97), confidence (P = .55), and accessing evidence (P = .27). Both groups showed significant gains in knowledge, attitudes, confidence, and accessing evidence from baseline to postcourse. Improvements in knowledge and confidence were sustained at 3-months.
A SPM learning module is as effective as a TDS module for application of EBM concepts and knowledge to patient care.
评估传统讲授式课程（TDS）与自定进度的交互式多媒体模块（SPM）相比，在医学生儿科住院实习期间应用循证医学（EBM）技能的效果。
2017年6月至2018年6月，我们在一家四级医疗儿童医院进行了一项随机对照试验。在每2周的时间段内，学生被随机分配到TDS组或SPM组。所有学生都使用标准化评估表完成了与临床问题相关证据的批判性评估工具（CAT），并对循证医学过程进行了自我反思。主要结局是使用经过验证的弗雷斯诺工具得出的CAT数值分数。使用经过验证的调查问卷测量与循证医学相关的知识、态度、信心和自我报告行为的次要结局。使用学生t检验分析CAT分数，并采用混合模型程序（PROC MIXED），将受试者作为随机效应，时间作为次要结局的重复测量因素。
纳入了127名临床实习学生。总体而言，TDS组（n = 59）和SPM组（n = 66）的平均CAT分数无显著差异（90.3对92.0，P = 0.65）。SPM组和TDS组在知识（P = 0.66）、态度（P = 0.97）、信心（P = 0.55）和获取证据方面（P = 0.27）均无显著差异。两组从基线到课程结束后在知识、态度、信心和获取证据方面均有显著提高。知识和信心的改善在3个月时得以维持。
在将循证医学概念和知识应用于患者护理方面，SPM学习模块与TDS模块同样有效。
