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1.  A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine 
BMC Medical Education  2015;15:39.
Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.
A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the ‘Assessing Competency in EBM’ (ACE) tool. Students’ self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.
A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=−0.68, (95% CI–1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.
BL is no more effective than DL at increasing medical students’ knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.
Electronic supplementary material
The online version of this article (doi:10.1186/s12909-015-0321-6) contains supplementary material, which is available to authorized users.
PMCID: PMC4358913  PMID: 25884717
Evidence based medicine; Assessment; Medical education; Blended learning
2.  Development and validation of the ACE tool: assessing medical trainees’ competency in evidence based medicine 
BMC Medical Education  2014;14:114.
While a variety of instruments have been developed to assess knowledge and skills in evidence based medicine (EBM), few assess all aspects of EBM - including knowledge, skills attitudes and behaviour - or have been psychometrically evaluated. The aim of this study was to develop and validate an instrument that evaluates medical trainees’ competency in EBM across knowledge, skills and attitude.
The ‘Assessing Competency in EBM’ (ACE) tool was developed by the authors, with content and face validity assessed by expert opinion. A cross-sectional sample of 342 medical trainees representing ‘novice’, ‘intermediate’ and ‘advanced’ EBM trainees were recruited to complete the ACE tool. Construct validity, item difficulty, internal reliability and item discrimination were analysed.
We recruited 98 EBM-novice, 108 EBM-intermediate and 136 EBM-advanced participants. A statistically significant difference in the total ACE score was observed and corresponded to the level of training: on a 0-15-point test, the mean ACE scores were 8.6 for EBM-novice; 9.5 for EBM-intermediate; and 10.4 for EBM-advanced (p < 0.0001). Individual item discrimination was excellent (Item Discrimination Index ranging from 0.37 to 0.84), with internal reliability consistent across all but three items (Item Total Correlations were all positive ranging from 0.14 to 0.20).
The 15-item ACE tool is a reliable and valid instrument to assess medical trainees’ competency in EBM. The ACE tool provides a novel assessment that measures user performance across the four main steps of EBM. To provide a complete suite of instruments to assess EBM competency across various patient scenarios, future refinement of the ACE instrument should include further scenarios across harm, diagnosis and prognosis.
PMCID: PMC4062508  PMID: 24909434
Evidence based medicine; Assessment; Medical students
3.  Implementation of a blended learning approach to teaching evidence based practice: a protocol for a mixed methods study 
BMC Medical Education  2013;13:170.
Evidence based practice (EBP) requires that health professionals are competent in integrating the best evidence in their decision making. Being 'evidence-based’ requires skills and knowledge in epidemiology, biostatistics and information literacy. EBP is commonly taught in medical and health sciences degrees, yet there is little evidence to guide educators as to the best teaching modality to increase learner competency in EBP.
This study is mixed methods in design. A randomised controlled trial will examine the effectiveness of blended learning versus didactic approach of teaching EBP to medical students. The primary outcome of the RCT is EBP competency as assessed by the Berlin tool. Focus groups will be conducted to explore student perceptions and attitudes towards implementing a blended learning approach in teaching EBP. A concurrent triangulation design will be implemented, permitting quantitative data to inform the effectiveness of the intervention and qualitative data to contextualise the results.
This study will provide novel evidence on the effectiveness of blended learning in teaching EBP to a cohort of undergraduate and graduate-entry medical students.
PMCID: PMC3878342  PMID: 24351113
4.  Adopting a blended learning approach to teaching evidence based medicine: a mixed methods study 
BMC Medical Education  2013;13:169.
Evidence Based Medicine (EBM) is a core unit delivered across many medical schools. Few studies have investigated the most effective method of teaching a course in EBM to medical students. The objective of this study was to identify whether a blended-learning approach to teaching EBM is more effective a didactic-based approach at increasing medical student competency in EBM.
A mixed-methods study was conducted consisting of a controlled trial and focus groups with second year graduate medical students. Students received the EBM course delivered using either a didactic approach (DID) to learning EBM or a blended-learning approach (BL). Student competency in EBM was assessed using the Berlin tool and a criterion-based assessment task, with student perceptions on the interventions assessed qualitatively.
A total of 61 students (85.9%) participated in the study. Competency in EBM did not differ between the groups when assessed using the Berlin tool (p = 0.29). Students using the BL approach performed significantly better in one of the criterion-based assessment tasks (p = 0.01) and reported significantly higher self-perceived competence in critical appraisal skills. Qualitative analysis identified that students had a preference for the EBM course to be delivered using the BL approach.
Implementing a blended-learning approach to EBM teaching promotes greater student appreciation of EBM principles within the clinical setting. Integrating a variety of teaching modalities and approaches can increase student self-confidence and assist in bridging the gap between the theory and practice of EBM.
PMCID: PMC3879412  PMID: 24341502
Evidence based medicine; Blended learning; Graduate medical education; Pedagogy
5.  Sicily statement on classification and development of evidence-based practice learning assessment tools 
BMC Medical Education  2011;11:78.
Teaching the steps of evidence-based practice (EBP) has become standard curriculum for health professions at both student and professional levels. Determining the best methods for evaluating EBP learning is hampered by a dearth of valid and practical assessment tools and by the absence of guidelines for classifying the purpose of those that exist. Conceived and developed by delegates of the Fifth International Conference of Evidence-Based Health Care Teachers and Developers, the aim of this statement is to provide guidance for purposeful classification and development of tools to assess EBP learning.
This paper identifies key principles for designing EBP learning assessment tools, recommends a common taxonomy for new and existing tools, and presents the Classification Rubric for EBP Assessment Tools in Education (CREATE) framework for classifying such tools. Recommendations are provided for developers of EBP learning assessments and priorities are suggested for the types of assessments that are needed. Examples place existing EBP assessments into the CREATE framework to demonstrate how a common taxonomy might facilitate purposeful development and use of EBP learning assessment tools.
The widespread adoption of EBP into professional education requires valid and reliable measures of learning. Limited tools exist with established psychometrics. This international consensus statement strives to provide direction for developers of new EBP learning assessment tools and a framework for classifying the purposes of such tools.
PMCID: PMC3221624  PMID: 21970731
6.  Teaching evidence based medicine literature searching skills to medical students during the clinical years - a protocol for a randomised controlled trial 
BMC Medical Education  2011;11:49.
Two of the key steps in evidence based medicine (EBM) are being able to construct a clinical question and effectively search the literature to source relevant information. No evidence currently exists that informs whether such skills should be taught to medical students during their pre-clinical years, or delivered to include both the pre-clinical and clinical years of study. This is an important component of curriculum design as the level of clinical maturity of students can affect their perception of the importance and uptake of EBM principles in practice.
A randomised controlled trial will be conducted to identify the effectiveness of delivering a formal workshop in EBM literature searching skills to third year medical students entering their clinical years of study. The primary outcome of EBM competency in literature searching skills will be evaluated using the Fresno tool.
This trial will provide novel information on the effectiveness of delivering a formal education workshop in evidence based medicine literature searching skills during the clinical years of study. The result of this study will also identify the impact of teaching EBM literature searching skills to medical students during the clinical years of study.
PMCID: PMC3156797  PMID: 21794173
7.  Undergraduate medical student perceptions and use of Evidence Based Medicine: A qualitative study 
BMC Medical Education  2010;10:58.
Many medical schools teach the principles of Evidence Based Medicine (EBM) as a subject within their medical curriculum. Few studies have explored the barriers and enablers that students experience when studying medicine and attempting to integrate EBM in their clinical experience. The aim of this study was to identify undergraduate medical student perceptions of EBM, including their current use of its principles as students and perceived future use as clinicians.
Third year medical students were recruited via email to participate in focus group discussions. Four focus groups were conducted separately across four hospital sites. All focus groups were conducted by the same facilitator. All discussions were transcribed verbatim, and analysed independently by the two authors according to the principles of thematic analysis.
Focus group discussions were conducted with 23 third-year medical students, representing three metropolitan and one rural hospital sites. Five key themes emerged from the analysis of the transcripts: (1) Rationale and observed use of EBM in practice, (2) Current use of EBM as students, (3) Perceived use of EBM as future clinicians, (4) Barriers to practicing EBM, and (5) Enablers to facilitate the integration of EBM into clinical practice. Key facilitators for promoting EBM to students include competency in EBM, mentorship and application to clinical disciplines. Barriers to EBM implementation include lack of visible application by senior clinicians and constraints by poor resourcing.
The principles and application of EBM is perceived by medical students to be important in both their current clinical training and perceived future work as clinicians. Future research is needed to identify how medical students incorporate EBM concepts into their clinical practice as they gain greater clinical exposure and competence.
PMCID: PMC2931522  PMID: 20718992
8.  What impact do posters have on academic knowledge transfer? A pilot survey on author attitudes and experiences 
Research knowledge is commonly facilitated at conferences via oral presentations, poster presentations and workshops. Current literature exploring the efficacy of academic posters is however limited. The purpose of this initial study was to explore the perceptions of academic poster presentation, together with its benefits and limitations as an effective mechanism for academic knowledge transfer and contribute to the available academic data.
A survey was distributed to 88 delegates who presented academic posters at two Releasing Research and Enterprise Potential conferences in June 2007 and June 2008 at Bournemouth University. This survey addressed attitude and opinion items, together with their general experiences of poster presentations. Descriptive statistics were performed on the responses.
A 39% return was achieved with the majority of respondents believing that posters are a good medium for transferring knowledge and a valid form of academic publication. Visual appeal was cited as more influential than subject content, with 94% agreeing that poster imagery is most likely to draw viewer's attention. Respondents also believed that posters must be accompanied by their author in order to effectively communicate the academic content.
This pilot study is the first to explore perceptions of the academic poster as a medium for knowledge transfer. Given that academic posters rely heavily on visual appeal and direct author interaction, the medium requires greater flexibility in their design to promote effective knowledge transfer. This paper introduces the concept of the IT-based 'MediaPoster' so as to address the issues raised within published literature and subsequently enhance knowledge-transfer within the field of academic medicine.
PMCID: PMC2795740  PMID: 19995448
9.  Assessing competency in Evidence Based Practice: strengths and limitations of current tools in practice 
Evidence Based Practice (EBP) involves making clinical decisions informed by the most relevant and valid evidence available. Competence can broadly be defined as a concept that incorporates a variety of domains including knowledge, skills and attitudes. Adopting an evidence-based approach to practice requires differing competencies across various domains including literature searching, critical appraisal and communication. This paper examines the current tools available to assess EBP competence and compares their applicability to existing assessment techniques used in medicine, nursing and health sciences.
Only two validated assessment tools have been developed to specifically assess all aspects of EBP competence. Of the two tools (Berlin and Fresno tools), only the Fresno tool comprehensively assesses EBP competency across all relevant domains. However, both tools focus on assessing EBP competency in medical students; therefore neither can be used for assessing EBP competency across different health disciplines. The Objective Structured Clinical Exam (OSCE) has been demonstrated as a reliable and versatile tool to assess clinical competencies, practical and communication skills. The OSCE has scope as an alternate method for assessing EBP competency, since it combines assessment of cognitive skills including knowledge, reasoning and communication. However, further research is needed to develop the OSCE as a viable method for assessing EBP competency.
Demonstrating EBP competence is a complex task – therefore no single assessment method can adequately provide all of the necessary data to assess complete EBP competence. There is a need for further research to explore how EBP competence is best assessed; be it in written formats, such as the Fresno tool, or another format, such as the OSCE. Future tools must also incorporate measures of assessing how EBP competence affects clinician behaviour and attitudes as well as clinical outcomes in real-time situations. This research should also be conducted across a variety of health disciplines to best inform practice.
PMCID: PMC2728711  PMID: 19656412

Results 1-9 (9)