Evidence based practice (EBP) is the integration of the best available research evidence with clinical expertise and patients' unique perspectives and circumstances to optimize healthcare outcomes[1
]. EBP knowledge and skills have become foundational principles for all health care professionals[2
]. The introduction in 1992 of formal methods for teaching evidence based medicine[3
] prompted health care educators to integrate EBP core principles into their curricula[4
]. To guide and measure this transformation, educators need comprehensive, valid, and practical instruments to assess learners' EBP knowledge and skills.
Educators are encouraged to develop EBP curricula that address the 5-step model described in the Sicily Statement on Evidence Based Practice[2
] as core principles of EBP (Table ). A comprehensive EBP knowledge and skills assessment should be based on this 5-step model. Although over one hundred instruments for evaluating EBP curriculum effectiveness have been identified[9
], only one - the Fresno Test (FT)[10
] - has established validity and reliability and covers a broad range of EBP knowledge and skills.
The original FT consists of two clinical scenarios, 7 short answer questions, and 5 fill-in-the-blank questions that assess knowledge and skills from steps 1-3 of the EBP model. Scoring the FT is based on a rubric with descriptions and examples of "excellent", "strong", "limited", "minimal" and "not evident" answers for each question. The instrument and scoring rubric are discipline-specific, and the psychometric properties of the original FT have been reported only for family medicine residents and faculty members[10
The FT is a commonly used outcome measure of EBP knowledge and skills[11
]. However, because it is discipline-specific, use in disciplines other than family medicine require modification and validation. The 7-item adapted
] developed for occupational therapists demonstrated acceptable psychometric properties and was responsive to change in EBP-novice occupational therapist learners. The adapted FT includes occupational therapy-specific clinical scenarios and scoring rubric examples. In addition to modifying discipline-specific content, the instrument developers deleted 5 fill-in-the-blank questions because the educational intervention under investigation did not address the topics assessed by those items (statistical calculation skills and knowledge about diagnostic and prognostic study design)[14
]. However, many EBP curricula include these topics[15
] and the 5 deleted items demonstrated strong psychometric properties in the original FT[10
]. Hence, the consequence of deleting the 5 fill-in-the-blank items is to narrow the instruments' assessment of core EBP principles for many curricula.
The physical therapy profession has embraced the inclusion of EBP in professional curricula[20
]. To date however, only self-report instruments have been developed to assess EBP knowledge and skills among physical therapists[22
]. Neither the original FT (specific to family medicine physicians), nor the adapted FT (specific to occupational therapists), is appropriate for assessment of physical therapists. Assessment of EBP curricula effectiveness in physical therapy education requires the development of a valid and reliable assessment of physical therapists' EBP knowledge and skills.
The original and adapted versions of the FT assess only steps 1-3 of the EBP model (ask, acquire, appraise); they do not assess step 4--the ability to integrate patient perspectives and clinical expertise with the best available research evidence[24
]. Knowledge and skills for integrating patient perspectives and clinical expertise with research evidence are integral to the definition and central premise of EBP[1
]. Failing to assess this knowledge sends an implicit message to learners that it is not important. Although other aspects of EBP (e.g.
, self-reflection [step 5], behaviour, beliefs, and care outcomes) are best assessed by other instruments, it is reasonable to expect the FT to address the core principles of EBP knowledge and skills from 4 of the 5 steps of the EBP model.
The purpose of this study was to develop and validate a modified FT to assess physical therapists' EBP knowledge and skills. Discipline-specific content of the original FT was modified and two questions were added to more comprehensively assess core EBP principles described in the 5-step model.