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Determinants of knowledge gain in evidence-based medicine short courses: An international assessment
Background: Health care professionals worldwide attend courses and workshops to learn evidence-based medicine (EBM), but evidence regarding the impact of these educational interventions is conflicting and of low methodologic quality and lacks generalizability. Furthermore, little is known about determinants of success. We sought to measure the effect of EBM short courses and workshops on knowledge and to identify course and learner characteristics associated with knowledge acquisition. Methods: Health care professionals with varying expertise in EBM participated in an international, multicentre before-after study. The intervention consisted of short courses and workshops on EBM offered in diverse settings, formats and intensities. The primary outcome measure was the score on the Berlin Questionnaire, a validated instrument measuring EBM knowledge that the participants completed before and after the course. Results: A total of 15 centres participated in the study and 420 learners from North America and Europe completed the study. The baseline score across courses was 7.49 points (range 3.97-10.42 points) out of a possible 15 points. The average increase in score was 1.40 points (95% confidence interval 0.48-2.31 points), which corresponded with an effect size of 0.44 standard deviation units. Greater improvement in scores was associated (in order of greatest to least magnitude) with active participation required of the learners, a separate statistics session, fewer topics, less teaching time, fewer learners per tutor, larger overall course size and smaller group size. Clinicians and learners involved in medical publishing improved their score more than other types of learners; administrators and public health professionals improved their score less. Learners who perceived themselves to have an advanced knowledge of EBM and had prior experience as an EBM tutor also showed greater improvement than those who did not. Interpretation: EBM course organizers who wish to optimize knowledge gain should require learners to actively participate in the course and should consider focusing on a small number of topics, giving particular attention to statistical concepts.
Training in general practice: Three contemporary controversies
In this essay we present Trisha Greenhalgh's intervention at the 2006 Wonca Europe Conference. The Author speaks about training, in particular about contemporary controversies emerging in our professional training. In teaching family medicine when we consider three aspects of learning we face up with an impact area: What should we know? We need to acquire knowledge necessary to our practice from research. What should we do? In order to answer this question, which includes the great part of medical activities, we should know ethical principles and human virtues. What should we dare to hope? To learn to use creativity and imagination both in scientific reasoning and in the human dimension of our practice. These reminders are then resumed by Giorgio Bert in a comment full of stimulus very useful for professional training in medicine.
Towards a broader agenda for training in critical appraisal
Much progress has been made in recent years towards an evidence-based approach to health care, ie the routine framing of an explicit decision sequence in the clinical encounter, the systematic search for published evidence, and the appraisal of relevant research articles. We argue that this is a commendable but limited milestone, and that training in evidence-based health care, particularly the use of critical appraisal techniques, is in need of a broader agenda. We outline a proposal through which the skills and attitudes needed for the critical appraisal of published articles may be applied to all other aspects of clinical practice, from planning research projects to presenting results and guidelines and peer review of articles submitted for publication.