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巴西医疗学校循证医学课程内容的共识。

Consensus on evidence-based medicine curriculum contents for healthcare schools in Brazil.

机构信息

Physical Therapy, Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil.

Centro de Medicina Baseada em Evidência, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil.

出版信息

BMJ Evid Based Med. 2021 Oct;26(5):248. doi: 10.1136/bmjebm-2020-111397. Epub 2021 Jan 13.

Abstract

OBJECTIVES

Healthcare professionals need to take into account their knowledge, skills and attitudes to develop a focused clinical question, perform an effective search of the literature, critically appraise the evidence, and apply to the clinical context and evaluate the effectiveness of the process. To date, there is a lack of consensus on evidence-based medicine (EBM) curriculum for undergraduate healthcare students in Brazil. The aim of this study was to develop a consensus on EBM curriculum contents for healthcare schools in Brazil considering expert opinion.

DESIGN

Modified three-round Delphi methodology.

SETTING

Online survey.

PARTICIPANTS

The expert panel was composed of 40 healthcare professionals from different specialties. Most of the participants (n=24; 60%) were female with the age between 30 and 44 years. Participants were also experts in the field of epidemiology, biostatistics or public health. The mean experience of experts in teaching EBM was 9.5 years.

MAIN OUTCOME MEASURES

An online questionnaire consisting of 89 items related to EBM was sent to the experts. The experts ranked each item of EBM curriculum considering the importance of each item as omitted, mentioned, explained or practised. The last section of the questionnaire was composed of 'additional content' where the experts evaluated only if an item should be included or not, the form of offering the EBM contents and the total workload (in hours/semester). Open-ended questions were present in each section to give the opportunity to experts to insert suggestions. Items that reached values greater than or equal to 70% of agreement among experts was considered definitive for the curriculum. Items between 51% and 69% of agreement were included for the next round and those items with less than or equal to 50% of agreement were considered unnecessary and were excluded. In the third round, the EBM contents were classified according to the degree of consensus as follow: strong (≥70% of agreement), moderate (51%-69% of agreement) and weak (50% of agreement) based on the maximum consensus reached.

RESULTS

Of the 89 initial contents, 32 (35.9%) reached a strong degree of consensus, 23 (25.8%) moderate degree of consensus, two (2.2%) weak degree of consensus and 35 items were not recommended (≤50% of agreement). The workload suggested by experts should be between 61 and 90 hour/semester and an EBM curriculum should be offered with epidemiology and biostatistics as prerequisites. Regarding the importance of each item, 29 (72.5%) should be explained and 25 (27.5%) should be practised with exercises.

CONCLUSIONS

The consensus on an EBM curriculum for Brazilian healthcare schools consists of 54 items. This EBM curriculum also presents the degree of consensus (strong, moderate and weak), the importance of each item (mentioned, explained and practised with exercises). A total workload of between 60 and 90 hours per semester was suggested and the EBM curriculum should be offered with epidemiology and biostatistics as prerequisites, but also EBM contents should be included within other disciplines throughout the entire undergraduate course.

摘要

目的

医疗保健专业人员需要考虑他们的知识、技能和态度,以提出一个重点突出的临床问题,对文献进行有效的检索,对证据进行批判性评估,并将其应用于临床环境中,评估该过程的有效性。迄今为止,巴西本科医疗保健专业学生的循证医学(EBM)课程缺乏共识。本研究旨在考虑专家意见,为巴西的医疗保健学校制定 EBM 课程内容的共识。

设计

改良的三轮德尔菲法。

设置

在线调查。

参与者

专家小组由来自不同专业的 40 名医疗保健专业人员组成。大多数参与者(n=24;60%)为女性,年龄在 30 至 44 岁之间。参与者也是流行病学、生物统计学或公共卫生领域的专家。专家在 EBM 教学方面的平均经验为 9.5 年。

主要观察指标

向专家发送了一份包含 89 个 EBM 课程内容项目的在线问卷。专家根据每个 EBM 课程内容项目的重要性,对每个项目进行了评估,即省略、提及、解释或实践。问卷的最后一部分是“附加内容”,专家仅评估是否应包含某个项目,提供 EBM 内容的形式以及总工作量(每学期/小时)。每个部分都有开放性问题,让专家有机会提出建议。在专家达成 70%以上的共识的项目被认为是课程的确定内容。在 51%至 69%的专家达成共识的项目被纳入下一轮,而那些达成共识低于或等于 50%的项目被认为是不必要的,将被排除。在第三轮中,根据最大共识达成的程度,EBM 内容被分为以下三个共识程度:强(≥70%的共识)、中(51%-69%的共识)和弱(50%的共识)。

结果

在最初的 89 个内容中,有 32 个(35.9%)达到了强烈的共识程度,23 个(25.8%)达到了中等共识程度,2 个(2.2%)达到了弱共识程度,35 个内容不被推荐(≤50%的共识)。专家建议的工作量应为 61 至 90 小时/学期,EBM 课程应与流行病学和生物统计学作为先修课程一同提供。关于每个项目的重要性,有 29 个(72.5%)应加以解释,有 25 个(27.5%)应通过练习加以实践。

结论

巴西医疗保健学校的 EBM 课程共识包括 54 个项目。本 EBM 课程还介绍了共识程度(强、中、弱)、每个项目的重要性(提及、解释和练习)。建议每学期的总工作量为 60 至 90 小时,EBM 课程应作为先修课程与流行病学和生物统计学一同提供,但也应在整个本科课程的其他学科中纳入 EBM 内容。

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