Previous research has demonstrated that medical students have insufficient knowledge of critical appraisal, a fundamental aspect of evidence-based medicine. We aimed to enhance medical students’ critical appraisal skills using an innovative mixed-methods programme.
Methods
We designed a 2-day, mixed-methods, national teaching programme, including an interactive lecture and workshop, quiz and viva-style examination. Course efficacy was assessed using pre- and post-course confidence questionnaires and a quiz adapted from the validated Berlin Questionnaire. Data were analysed primarily using Wilcoxon Signed Ranks test.
Results
Fifty-nine participants from 17 medical schools completed the programme. Pre- and post-course scores demonstrated significant improvement in confidence (median score 5 vs 8; p < 0.001) and quiz performance (median score 9 vs 13; p < 0.001).
Conclusion
Our study demonstrates the efficacy of a novel mixed-methods programme in teaching medical students about critical appraisal. Implementation of our approach within the undergraduate curriculum should enhance the uptake of these fundamental skills.
BurlsA. What is Critical Appraisal? Evidence-Based Medicine2nd ed.London: Hayward Medical Communications; 2009
2.
DrussBG, MarcusSC. Growth and decentralization of the medical literature: implications for evidence-based medicine. J Med Libr Assoc2005; 93: 499–501.
3.
LandhuisE. Scientific literature: Information overload. Nature2016; 535: 457–8.
4.
Information overload. Nature2009; 460:551.
5.
ClancyC, CollinsFS. Patient-Centered Outcomes Research Institute: the intersection of science and health care. Sci Transl Med2010; 2: 37cm18.
6.
GabrielSE, NormandS-LT. Getting the methods right — the foundation of patient-centered outcomes research. N Engl J Med2012; 367: 787–90.
7.
Engineering a Learning Healthcare System. Washington, DC: National Academies Press; 2011.
8.
WeightmanAL, WilliamsonJ. The value and impact of information provided through library services for patient care: a systematic review. Heal Inf Libr J2005; 22: 4–25.
9.
MooreM. Teaching physicians to make informed decisions in the face of uncertainty: librarians and informaticians on the health care team. Acad Med2011; 86:1345.
10.
DawesM, SummerskillW, GlasziouP. Sicily statement on evidence-based practice. BMC Med Educ2005; 5:1.
BurrowsSC, TylmanV. Evaluating medical student searches of MEDLINE for evidence-based information: process and application of results. Bull Med Libr Assoc1999; 87: 471–6.
13.
AldugiemanTZ, AlaneziRS, AlshammariWMG. Knowledge, attitude and perception toward evidence-based medicine among medical students in Saudi Arabia: analytic cross-sectional study. J Fam Med Prim Care2018; 7: 1026–31.
14.
WindishDM, HuotSJ, GreenML. Medicine residents’ understanding of the biostatistics and results in the medical literature. JAMA2007; 298:1010.
15.
HryciwN, KnoxA, ArnejaJS. How well are we doing at teaching critical appraisal skills to our residents? A needs assessment of plastic surgery journal club. Plast Surg2017; 25: 261–7.
16.
WidyaheningIS, FindyartiniA, RanakusumaRW. Evaluation of the role of near-peer teaching in critical appraisal skills learning: a randomized crossover trial. Int J Med Educ2019; 10: 9–15.
17.
WeberschockTB, GinnTC, ReinholdJ. Change in knowledge and skills of Year 3 undergraduates in evidence-based medicine seminars. Med Educ2005; 39: 665–71.
18.
Sánchez-MendiolaM, Kieffer-EscobarLF, Marín-BeltránS. Teaching of evidence-based medicine to medical students in Mexico: a randomized controlled trial. BMC Med Educ2012; 12:107.
19.
MilinkovicD, FieldN, AgustinCB. Evaluation of a journal club designed to enhance the professional development of radiation therapists. Radiography2008; 14: 127–7.
20.
CramerJS, MahoneyMC. Introducing evidence based medicine to the journal club, using a structured pre and post test: a cohort study. BMC Med Educ2001; 1:6.
21.
KhajuriaA, ChengK, LevyJ. Effect of a national focused course on academic medicine for UK candidates applying for a clinical academic programme. J R Coll Physicians Edinb2017; 1: 65–9.
22.
SalbachNM, JaglalSB. Creation and validation of the evidence-based practice confidence scale for health care professionals. J Eval Clin Pract2011; 17: 764–800.
23.
FritscheL, GreenhalghT, Falck-YtterY. Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. Br Med J2002; 325:1338.
24.
MarantzPR, BurtonW, Steiner-GrossmanP. Using the case-discussion method to teach epidemiology and biostatistics. Acad Med2003; 78: 365–71.
25.
FreemanJV, CollierS, StaniforthD. Innovations in curriculum design: a multi-disciplinary approach to teaching statistics to undergraduate medical students. BMC Med Educ2008; 8:28.
26.
KolbDA. Experiential Learning: Experience as the Source of Learning and DevelopmentUSA: Prentice Hall Inc.; 1984.
27.
CoffieldF, MoseleyD, HallE. Learning styles and pedagogy in post-16 learning: a systematic and critical review | VOCEDplus, the international tertiary education and research database. https://www.voced.edu.au/content/ngv:13692 [accessed 20 October 2019].
28.
Hernández-TorranoD, AliS, ChanCK. First year medical students’ learning style preferences and their correlation with performance in different subjects within the medical course. BMC Med Educ2017;17.
29.
EngelsPT, De GaraC. Learning styles of medical students, general surgery residents, and general surgeons: Implications for surgical education. BMC Med Educ2010;10.
30.
SamarakoonL, FernandoT, RodrigoC. Learning styles and approaches to learning among medical undergraduates and postgraduates. BMC Med Educ2013; 13
31.
FeeleyAM, BiggerstaffDL. Exam success at undergraduate and graduate-entry medical schools: is learning style or learning approach more important? A critical review exploring links between academic success, learning styles, and learning approaches among school-leaver entry. Tradi Teach Learn Med2015; 27: 237–44.
32.
AlghashamAA. Effect of students’ learning styles on classroom performance in problem-based learning. Med Teach2012;34.
33.
HamdanA. Medical students still lack skills needed to practise evidence-based medicine. J R Soc Med2012; 105:324.
34.
OlogundeR, Di SalvoI, KhajuriaA. The CanMEDS scholar: the neglected competency in tomorrow's doctors. Adv Med Educ Pract2014:383.
35.
Astin J, Jenkins T, Moore L. Medical students’ perspective on the teaching of medical statistics in the undergraduate medical curriculum. Stat Med 2002; 21: 1003–6.
36.
WindishDM, HuotSJ, GreenML. Medicine residents’ understanding of the biostatistics and results in the medical literature. JAMA2007; 298:1010.
37.
WindishDM. Brief curriculum to teach residents study design and biostatistics. BMJ Evidence Based Med2011; 16: 100–4.
38.
OdiernaDH, WhiteJ, ForsythS. Critical appraisal training increases understanding and confidence and enhances the use of evidence in diverse categories of learners. Heal Expect2015; 18: 273–87.
39.
IoannidisJPA, StuartME, BrownleeS. How to survive the medical misinformation mess. Eur J Clin Invest2017; 47: 795–802.
40.
FarrellPM, GrossmanJ. Using science to improve health care delivery and patient care Dean's Corner. Wisconsin Med J2004; 103: 87–8.
41.
KragM, MarkerS, PernerA. Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. N Engl J Med2018; 379: 2199–208.
