Medical students still lack skills needed to practise evidence-based medicine

We read with interest the recent article by Banerjee et al. ¹ and like the authors, we agree that evidence-based medicine and quality improvement are vital in improving healthcare delivery in the NHS. However, unlike the authors, we do not think that evidence-based medicine is adequately incorporated in the undergraduate medical curriculum. Based on our experience and previously published studies, ^2–4 key skills needed to practise evidence-based medicine such as critical appraisal, research methodology and medical statistics are still not being adequately taught at medical school, despite clear recommendations by the General Medical Council. ⁵ If this was true, medical students may not have adequate knowledge on evidence-based medicine to help them embrace principles of quality improvement, as discussed in the article. ¹

To explore this issue, we undertook a five-point Likert-scale questionnaire survey of 101 medical students from 18 UK medical schools attending an academic medicine conference. A response rate of 81.8% (82/101) was achieved (41.5% men, mean age 22.5 years). Of 82 medical students, only 32.9% regularly read medical journals, 56.1% knew how to critically appraise journal articles and 64.6% did not have a good understanding of basic research methodology. Moreover, only 37.8% of medical students understood basic medical statistics and 31.6% knew how to perform basic statistical calculations. These findings suggest that medical students lack important skills needed to practice evidence-based medicine. More worryingly, it is likely that our findings understate the actual situation at medical schools (given our sample population of research-oriented students).

It has been suggested that medical students are reluctant to learn about critical appraisal, research methodology and medical statistics because they do not see the translational benefit in clinical practice. ^2–4 A curriculum that teaches evidence-based medicine (clinical knowledge) and quality improvement (clinical translation) simultaneously could ameliorate this lack of interest.