Faculty of Social Sciences, University of Stirling, FK9 4LA, Stirling, UK.
Australian National University, Canberra, Australia.
BMC Med Educ. 2021 Jan 12;21(1):45. doi: 10.1186/s12909-021-02490-5.
Evidence-based practice is an important component of pre-service professional learning in medicine and allied health degrees, including new programmes in paramedicine. Despite substantial interest in this area, there is still a lack of clear understanding of how the skills and understandings needed to develop the capacity to apply evidence-based practice can best be learned. Evidence-based practice is often described as consisting of five steps: ask, acquire, appraise, apply and assess. This study focuses on paramedicine students' learning about the first three steps in a final year unit which explicitly aims to develop their skills in relation to these.
We conducted a qualitative study of learning journals recorded by 101 of 121 students in a final year unit of a paramedicine degree (20 students either withheld consent for their journals to be used in the research or did not complete their journal entries). We used phenomenographic approaches to the data analysis in order to identify both variation in students' learning and the factors affecting this variation.
We observed variation in students' understanding of the purpose of literature analysis, the nature of medical research and its relationship to practice. In all three, we identify two main factors contributing to the variation in student learning outcomes: epistemological stance, and opportunities for metacognitive learning generated through peer interactions and self-reflection. We also found that as students begin to grapple with the complexity of medical research, this sometimes produced negative attitudes towards its value; such unintended outcomes need to be recognised and addressed.
We suggest key factors that should be considered in developing coursework intended to enhance students' understandings about the processes and application of evidence-based practice. Providing collaborative learning opportunities that address the architecture of variation we observed may be useful in overcoming epistemological and metacognitive barriers experienced by students.
循证实践是医学和相关健康专业学位（包括新的急救医学专业）职前专业学习的重要组成部分。尽管人们对此领域非常感兴趣，但对于如何最好地学习发展循证实践能力所需的技能和理解，仍缺乏清晰的认识。循证实践通常被描述为包括五个步骤：询问、获取、评价、应用和评估。本研究聚焦于急救医学专业学生在一门最后学年单元中对前三个步骤的学习，该单元明确旨在发展他们在这方面的技能。
我们对 121 名急救医学学位最后学年单元学生（20 名学生因不同意将其日志用于研究或未完成其日志条目而被排除）中 101 名学生的学习日志进行了定性研究。我们使用现象学方法对数据进行分析，以确定学生学习的差异以及影响这种差异的因素。
我们观察到学生对文献分析目的、医学研究的性质及其与实践的关系的理解存在差异。在这三个方面，我们确定了导致学生学习成果差异的两个主要因素：认识论立场以及通过同伴互动和自我反思产生的元认知学习机会。我们还发现，随着学生开始应对医学研究的复杂性，他们有时会对其价值产生负面态度；这种意外的结果需要得到认可和解决。
我们建议在开发旨在增强学生对循证实践过程和应用的理解的课程时，应考虑一些关键因素。提供解决我们观察到的差异结构的协作学习机会可能有助于克服学生遇到的认识论和元认知障碍。
