Basheer Aneesh, Iqbal Nayyar, Prabakaran Stalin, Simiyon Manjula, Anandan Velavan
General Medicine, DM Wayanad Institute of Medical Sciences, Wayanad, IND.
General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, IND.
Cureus. 2021 Nov 27;13(11):e19946. doi: 10.7759/cureus.19946. eCollection 2021 Nov.
The ideal method to teach evidence-based medicine (EBM) to medical students is unclear. We determined the effectiveness of a simulated randomized controlled trial (RCT) in improving critical appraisal and EBM skills among medical students compared to traditional training.
One hundred and eighteen medical students were randomized into two groups. Sixty-one students (immersion arm) were trained in critical appraisal using a simulated RCT aimed at determining efficacy of a "brainy pill" on ability to crack puzzles. Fifty-seven students (traditional group) were trained using a journal club with a checklist. Primary outcome of change in knowledge and skills of critical appraisal and EBM was determined by comparing scores on pre- and post-intervention Fresno tests.
Mean age of students was 21.76 (SD - 0.78) years. Seventy (59.3%) were females and 48 (40.7%) males. Mean pre-test scores of traditional and immersion groups were 8.0 (SD - 4.88) and 9.31 (SD - 5.49) respectively and post-test scores were 50.2 (SD - 16.2) and 68.12 (SD - 14.72) respectively (post-intervention mean difference - 17.92; 95% CI 12.26 - 23.57; p<0.0000001). Odds of achieving 65% or more in post-intervention Fresno test score was significantly higher in immersion group (29.8% vs 8.2%; OR 4.76; 95% CI 1.62-13.97; p = 0.001). Perceived competence regarding EBM skills improved significantly in immersion group.
Simulated RCT is effective in imparting critical appraisal and EBM practice skills to medical students. Trainers should consider integrating and reinforcing this approach in EBM curriculum to make learning contextual and immersive.
向医学生传授循证医学（EBM）的理想方法尚不清楚。我们比较了模拟随机对照试验（RCT）与传统培训在提高医学生批判性评价和循证医学技能方面的有效性。
118名医学生被随机分为两组。61名学生（沉浸式组）通过模拟RCT接受批判性评价培训，该模拟RCT旨在确定一种“健脑丸”对解谜能力的疗效。57名学生（传统组）通过带有检查表的期刊俱乐部进行培训。通过比较干预前后弗雷斯诺测试的分数来确定批判性评价和循证医学知识与技能变化的主要结果。
学生的平均年龄为21.76（标准差 - 0.78）岁。70名（59.3%）为女性，48名（40.7%）为男性。传统组和沉浸式组的预测试平均分数分别为8.0（标准差 - 4.88）和9.31（标准差 - 5.49），后测试分数分别为50.2（标准差 - 16.2）和68.12（标准差 - 14.72）（干预后平均差异 - 17.92；95%置信区间12.26 - 23.57；p<0.0000001）。沉浸式组在干预后弗雷斯诺测试分数达到65%或更高的几率显著更高（29.8%对8.2%；优势比4.76；95%置信区间1.62 - 13.97；p = 0.001）。沉浸式组对循证医学技能的感知能力有显著提高。
模拟RCT在向医学生传授批判性评价和循证医学实践技能方面是有效的。培训师应考虑在循证医学课程中整合和强化这种方法，以使学习具有情境性和沉浸感。
