Assistant Director for Medical Education and Access Services Indiana University Indianapolis, Indiana
Introduction: Faculty are increasingly being called upon to teach medical students the skills necessary to have a strong foundation in evidence-based medicine (EBM) before they move on to the professional phase of their education. All too often, the expectation is that these skills can be imparted in a class or two when the curriculum allows. Prior to the inception of this study, our institution had been teaching EBM within a discrete 2-month time period during medical students’ first year. During a large-scale curricular overhaul, the approach to teaching EBM was changed to a more scaffolded, integrated approach with sessions being taught over the course of two years. In this study, we assess the differential impact of these two approaches to teaching EBM in the first two years of medical school.
Objectives: This research project aims to determine the potential differential impact of two curricular approaches to teaching EBM on student performance on an EBM assignment administered during the first year of clerkship.
Methods: In order to assess and compare student learning under the different curricula, the PI and a team of five faculty members used a modified version of the previously validated Fresno rubric to grade three years’ worth of EBM assignments given to students in clerkship rotations 1-3 (n = 481) during the Internal Medicine clerkship. Specifically, EBM performance in three separate student cohorts were examined. Assignments were anonymized before being randomly assigned to graders, and all possible student and date identifying information was removed.
Results: Four hundred and eighty-one assignments were graded. Mean scores were compared for individual questions and cumulative scores using a one-way Welch ANOVA test. Overall, students performed .99 of a point better on the assignment from Year One (Y1), prior to EBM curriculum integration to Year Three (Y3), subsequent to EBM integration (p= <.001). Statistically significant improvement was seen on questions measuring students’ ability to formulate a clinical question and critically appraise medical evidence.
Conclusions: Results of this study suggest that taking a scaffolded, curriculum-integrated approach to EBM instruction during the pre-clinical years increases student retention of and ability to apply EBM concepts to patient care. Although it is difficult to fully attribute students’ retention and application of EBM concepts to the adoption of a curricular model focused on scaffolding and integration, the results of this study show that there are value-added educational effects to teaching EBM in this new format.