Objectives Multifaceted, clinically integrated teaching of Evidence Based Medicine (EBM) with assessments are more likely to improve students’ knowledge, skills and attitudes. Currently, there is limited evidence on what are the minimum components of the multifaceted interventions or on the most effective models of clinically integrating EBM teaching. The aim of this study is to evaluate the effectiveness of two different models of clinically integrating EBM teaching – blended or online learning.
Method EBM is a progressive longitudinal theme in the University of Buckingham Medical School, where students are taught to ask, acquire and appraise evidence in years one and two (phase I). In years three and four (phase II), students are asked to apply EBM in clinical practice and reflect on their experience. All students received the same educational intervention for phase I. Students in phase II are placed at one of two hospitals, where they received either blended learning (a combination of lectures, facilitated small group discussions) or online learning (recorded lectures and online learning resources).
Learning outcomes assessed included students’ EBM knowledge, skills and behaviour using the validated assessment tool- Assessing Competency in Evidence Based Medicine (ACE). In addition, students were asked to complete educational prescriptions (EP) - where they developed a question from a clinical scenario, searched and appraised evidence and applied it to the clinical decision.
Results Education was delivered to 65 students, from which 46 students completed the ACE test (32 blended/14 online). There were 31 EP submissions (23 blended/8 online learning). Students’ performances in both the ACE test and EP were better in the blended learning model compared to online learning. The mean difference for performances in ACE and EP were 1.02 (one tailed p value <0.05) and 2.29 (p <0.05) respectively.
This study was a pragmatic trial; hence it was not possible to either randomise or blind individual students to the interventions. The blended learning approach was resource intensive and needed a lot of planning and commitment. It was feasible in this small teaching hospital with a small cohort of students- whether it is applicable in larger teaching hospitals with bigger cohorts of students is uncertain.
Conclusions Our study demonstrates that it was feasible to offer both models of clinically integrated EBM teaching. Blended learning model is more effective than online learning for clinically integrating EBM teaching as demonstrated by the medical students’ competency in EBM knowledge, skills and behaviour using validated assessment tools such as the ACE and EP. In designing teaching methods for clinically integrating EBM, educators need to balance resource implications, students’ preferences and impact on learning outcomes. Further research into the minimum components needed for multifaceted interventions and the most efficient models of clinically integrating EBM teaching is needed.
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