The EU-EBM curriculum presented in this paper targets postgraduate training and continuing education, using a clinically integrated e-learning methodology. To our knowledge, clinically integrated teaching of EBM is currently not provided in Europe. Furthermore, existing courses do not have a comparable format with continuous repetitive learning over a longer period, which includes small activities and individualised assignments to acquire skills and to deepen knowledge, standardised assessments at the end of each module and special emphasis on implementation of evidence in practice. Furthermore, one of the main innovations here is to get European countries to work together in order to harmonize an integrated teaching of EBM, which has not been subject of any harmonization effort before.
The main purpose of the curriculum is to provide doctors with the basic skills needed to practice and implement evidence-based therapy. For this, the course covers the 5 key steps of evidence based practice, namely framing the clinical question, searching for the evidence, appraisal and interpretation of the evidence, applying the evidence to the patient and implementing the evidence into practice, using problems encountered in daily patient care. An e-learning platform [28
] or access through CD-Rom ensures timely and immediate access to the necessary methodological knowledge and background materials. The development, piloting and certification of a basic clinically integrated course in EBM offers the learner the opportunity for a standardised acquisition of EBM skills, promotes life long learning, and increases the mobility of doctors within a unified region such as the European Union.
A distinct feature of the EU-EBM curriculum is the low threshold approach to facilitate integrated EBM teaching and thereby addressing specific problems of the target group. Teaching basic concepts in short learning units and allowing maximum flexibility in the location of the learning takes into account the timeframe and working patterns of busy clinicians. The course separates the practice of EBM in the day-to-day patient encounter (framing questions from patients' problems, identifying the literature and applying the evidence to the individual patient) from the acquisition of methodological knowledge (critical appraisal of clinical research) which is mainly taught on the e-learning platform. An EBM enthusiastic senior clinician can act as a moderator in this learning process, but is not expected to teach the methodology of EBM. This division of responsibilities fosters the spread of EBM-teaching and learning to clinical settings with strong interest for EBM but with a lack of specialists teaching the methodology of critical appraisal. Inspired learners will receive additional reading material and guidance on how to advance their skills. Furthermore, groups of residents could pass the course simultaneously as part of their in-house training. We envision that this joint learning experience might stimulate constructive critical reflection on current clinical practice beyond the specific course content, initiating a new culture of discussion and EBM-practice within a department or unit. Last but not least, the translation of the curriculum in French, German, Spanish, Hungarian and Polish should help non-native English speakers to learn new concepts in their own language and ensure greater accessibility of the learning materials.
The key aims of this project will need to be met by raising awareness of the importance of training in EBM throughout Europe as a means of enabling health care professionals to provide better care to patients [13
] and ultimately encouraging the inclusion of the qualification developed into mainstream education. The dissemination systems in place such as the website [28
], presentations on national conferences and workshops, word of mouth and publications in national language will allow access, discussion and dissemination of the results. The project partners started already to share the knowledge and experience from this project with their national networks of institutions that might benefit from the process. Many organisations and institutions look for "easy to use" learning programs in EBM that they can integrate -with limited resources- in their local working environment. We further encourage the incorporation of this course in existing educational lessons offered by other institutions, which will then hopefully form the established network for an exchange of training practices and experiences. Dissemination to good educational practice when successful can help to create a level playing field for mobility of doctors and other clinical professions.
So far, in this pilot project, we only covered one unit of EBM, namely systematic review of therapeutic effectiveness, due to time and financial constraints. Furthermore, the current program is designed for medical doctors. However, numerous organisations of allied health professionals already expressed interest in this course as did consumer organisations and patient self-help groups. We need testing of the existing course in those groups and modify it according to their learning needs. Furthermore, the course is so far only available in six different languages. Additional translation in other European and non-European languages might be warranted. The curriculum assessment currently contains evaluation of participants' knowledge, skills, and attitudes. Although we acknowledge that behavioural changes are essential to fully implement life long learning, measurement of such changes require longer follow-up than is possible within the current duration of this pilot-project.
Once fully implemented, the ultimate outcome of this pilot project will be a European qualification in EBM, which will be used by doctors, hospitals, professional bodies responsible for postgraduate qualifications and continuous medical education. In the long term this project has the potential to benefit the general public as EBM will contribute to a more transparent healthcare system, better-informed patients and a generally better informed society, which is what EBM is all about.