Green M L, Ellis P J
Yale University School of Medicine, Department of Internal Medicine, New Haven, Conn., USA.
J Gen Intern Med. 1997 Dec;12(12):742-50. doi: 10.1046/j.1525-1497.1997.07159.x.
To develop and implement an evidence-based medicine (EBM) curriculum and determine its effectiveness in improving residents' EBM behaviors and skills.
Description of the curriculum and a multifaceted evaluation, including a pretest-posttest controlled trial.
University-based primary care internal medicine residency program.
Second- and third-year internal medicine residents (N = 34).
A 7-week EBM curriculum in which residents work through the steps of evidence-based decisions for their own patients. Based on adult learning theory, the educational strategy included a resident-directed tutorial format, use of real clinical encounters, and specific EBM facilitating techniques for faculty.
Behaviors and self-assessed competencies in EBM were measured with questionnaires. Evidence-based medicine skills were assessed with a 17-point test, which required free text responses to questions based on a clinical vignette and a test article. After the intervention, residents participating in the curriculum (case subjects) increased their use of original studies to answer clinical questions, their examination of methods and results sections of articles, and their self-assessed EBM competence in three of five domains of EBM, while the control subjects did not. The case subjects significantly improved their scores on the EBM skills test (8.5 to 11.0, p = .001), while the control subjects did not (8.5 to 7.1, p = .09). The difference in the posttest scores of the two groups was 3.9 points (p = .001, 95% confidence interval 1.9, 5.9).
An EBM curriculum based on adult learning theory improves residents' EBM skills and certain EBM behaviors. The description and multifaceted evaluation can guide medical educators involved in EBM training.
制定并实施基于循证医学（EBM）的课程，并确定其在改善住院医师循证医学行为和技能方面的有效性。
课程描述及多方面评估，包括前后测对照试验。
大学附属基层医疗内科住院医师培训项目。
内科二年级和三年级住院医师（N = 34）。
为期7周的循证医学课程，住院医师通过该课程为自己的患者完成循证决策的各个步骤。基于成人学习理论，教育策略包括以住院医师为主导的辅导形式、使用真实临床病例以及为教员提供特定的循证医学促进技巧。
使用问卷测量循证医学方面的行为和自我评估能力。通过一项17分的测试评估循证医学技能，该测试要求根据临床病例和一篇测试文章对问题进行自由文本回答。干预后，参与课程的住院医师（病例组）增加了对原始研究的使用以回答临床问题、对文章方法和结果部分的审查，并且在循证医学五个领域中的三个领域自我评估的循证医学能力有所提高，而对照组则没有。病例组在循证医学技能测试中的分数显著提高（从8.5分提高到11.0分，p = .001），而对照组没有（从8.5分降至7.1分，p = .09）。两组后测分数的差异为3.9分（p = .001，95%置信区间1.9, 5.9）。
基于成人学习理论的循证医学课程可提高住院医师的循证医学技能和某些循证医学行为。该课程描述和多方面评估可为参与循证医学培训的医学教育工作者提供指导。
