Learners can be doctors, patients, policy makers, or managers. This article focuses on doctors, but our evaluation framework could be applied to other audiences.
Credit: PHILIP SIMPSON/PHOTONICA
Not all doctors want or need to learn how to practise all five steps of EBM (asking, acquiring, appraising, applying, assessing).4,5
Indeed, most doctors consider themselves users of EBM, and surveys of clinicians show that only about 5% believe that learning all these five steps is the most appropriate way of moving from opinion based to evidence based medicine.4
Doctors can incorporate evidence into their practice in three ways.3,6
In a clinical situation, the extent to which each step of EBM is performed depends on the nature of the encountered condition, time constraints, and level of expertise with each of the steps. For frequently encountered conditions (such as unstable angina) and with minimal time constraints, we operate in the “doing” mode, in which at least the first four steps are completed. For less common conditions (such as aspirin overdose) or for more rushed clinical situations, we eliminate the critical appraisal step and operate in the “using” mode, conserving our time by restricting our search to rigorously preappraised resources (such as Clinical Evidence
). Finally, in the “replicating” mode we trust and directly follow the recommendations of respected EBM leaders (abandoning at least the search for evidence and its detailed appraisal). Doctors may practise in any of these modes at various times, but their activity will probably fall predominantly into one category.
The various methods of teaching EBM must therefore address the needs of these different learners. One size cannot fit all. Similarly, if a formal evaluation of the educational activity is required, the evaluation method should reflect the different learners' goals. Although several questionnaires have been shown to be useful in assessing the knowledge and skills needed for EBM,7,8
we must remember that learners' knowledge and skills targeted by these tools may not be similar to our own. The careful identification of our learners (their needs and learning styles) forms the first dimension of the evaluation framework that we are proposing.