A prospective mixed-methods study evaluating the integration of an evidence based medicine curriculum into an internal medicine residency program

Abstract

Introduction: Evidence based medicine (EBM) skills are often lacking in the general internal medicine physician population. Our aim is to evaluate the impact of our internal medicine EBM curriculum on the residents’ EBM skills and knowledge through mixed methods. Methods: A prospective study was performed that evaluated the EBM curriculum: quanti-tatively, with pre/posttests and qualitatively through a focus group that addressed residents’ opinion on the educational and clinical impact of each aspect of the curriculum. Results: A total of 60 internal medicine residents were surveyed. Short-term EBM skills: therapy workshops (N=25) median pretest score of 8 (IQR): [6–9]) vs posttest 8 (IQR: [8–9]), (p=0.006); diagnosis (N=16) pretest score of 6 (IQR: [3–6]) vs posttest 7 (IQR: [6–9]), (p=0.006); systematic review (N=13) pretest score of 4 (IQR: [4–6]) vs posttest 7 (IQR: [6–8]), (p=0.002); and harm (N=16) pretest score of 6 (IQR: [5–7]) vs posttest 7 (IQR: [7–8]), (p=0.004). Long-term EBM skills: Fresno test of competence in EBM, pretest median score of 110.5/212 (IQR: 96.0–124.0) and a median posttest score of 115/212 (IQR: 100.0–130.0) (p=0.60). Having previous EBM training, being actively involved in research and being the first author on a publication was associated with higher Fresno test scores. Focus group provided qualitative feedback on the residents’ EBM curriculum perception. Conclusion: This curriculum adds a significant contribution to the current field of medical education as it fills an important educational gap, through defining ways of effectively delivering EBM concepts which led to improvement in residents’ ability to evaluate and apply medical literature. The EBM curriculum was overall well received by the residents.