Peer Teaching of Evidence-Based Medicine for Undergraduate Students
EL Rees, Y Sinha, AR Chitnis, J Archer, V Fotheringham, S Renwick
School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
Background
Defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of ind ividual patients”1 evidence-based medicine (EBM) is
incorporated into the undergraduate curricula of many medical schools.
M e d i c a l s t u d e n t s p e r c e i v e E B M t o b e v a l u a b l e t o t h e i r u n d e r g r a d u a t e a n d p o s t g r a d u a t e c a r e e r 2 , 3 . T h e r e a r e , h o w e v e r, m a n y b a r r i e r s t o s t u d e n t s a p p l y i n g E B M p r i n c i p l e s t o t h e i r
studies. One such barrier is ineffective searching for evidence based guidelines and identifying high quality resources. 2
NICE Evidence Search (formerly NHS Evidence) is a service provided by the National Institute for Health and Care Excellence ( NICE) that enables access to authoritative clinical
and non-clinical evidence and best practice through a web -based portal.4
Summary of work
With the assistance of NICE, we designed, implemented, and evaluated a peer -taught workshop on the principles finding high quali ty evidence. We aimed to promote the use of,
and improve students’ ability to find, evidence -based resources focussing on the NICE Evidence Search web portal. The Workshops were organised and delivered by fourth year
medical students who had received training from NICE to become Evidence Search‘ student champions’. The student champions at tended a one day course that focussed on how
t o u s e N I C E E v i d e n c e S e a r c h m o r e e f f e c t i v e l y, a n d o n t e a c h i n g s k i l l s f o r t h e f a c i l i t a t i o n o f w o r k s h o p s . 5
Teaching of EBM principles
Hands-on teaching about NICE Evidence Search
Key features of the workshops:
•
For students of years 1-3
•
Vo l u n t a r y
•
1 hour session
•
Ta i l o r e d t o c u r r e n t t o p i c s
Evaluation of workshops:
Clinical scenario given
Students formulate question
Students search for answer
Pre-workshop survey
•
Post-workshop survey 8-12 weeks
Responses measured using audience feedback system
Results displayed to group
Answers discussed and student demonstrates process
Summary of results
How often do you search for information as part of your studies?
Have you used Evidence Search since attending the Student
Champion learning session?
191 medical students attended:
70.0%
63.5%
Ye a r 1 , n = 4 4 ( 3 8 % o f c o h o r t )
60.0%
Ye a r 2 , n = 8 2 ( 5 5 % o f c o h o r t )
50.0%
Ye a r 3 , n = 6 4 ( 4 9 % o f c o h o r t )
90.0%
80.0%
77.2%
70.0%
40.0%
% of respondents
% of respondents
•
60.0%
50.0%
30.0%
Response rates:
17.6%
20.0%
90% - pre-workshop survey
11.8%
10.0%
59% - post-workshop survey
2.9%
2.4%
0.0%
Daily multiple
times
Daily - once
Weekly multiple
times
Weekly once
Monthly multiple
times
1.8%
0.0%
Monthly once
40.0%
27.7%
30.0%
19.8%
20.0%
5.9%
10.0%
0.0%
Yes to help with
my studies
Less often
Yes for general
searching
Pre-workshop findings:
Frequency
2.0%
Yes to familarise No but I plan to
myself with the
site
Responses
No
52% - searched for evidence-based resources
How confident are you searching for health and social care
information online?
1% - evidence-based resources as 1st preference
90
80
40
70
30
60
Post-workshop findings:
50
45
86% - find Evidence Search ‘useful’ or ‘very useful’
40
30
87% - ‘confident’ or ‘very confident’ searching
27
24
31% - Evidence Search resources as 1st preference
20
11
10
2
2
0
Very unconfident
2
1
34
35
% of respondents
% of respondents
80
Which resources do you use for accessing health & social care
information? (1st preference)
29% - ‘confident’ or ‘very confident’ searching
7
31
30
28
28
25
20
17
15
14
13
10
5
5
1
0
Unconfident
Neither confident
Confident
nor unconfident
Confidence with searching
Pre-workshop (%)
Very confident
Search engine
Post-workshop (%)
Textbooks
Journals
Websites
Evidence-based
Resources
guidelines
1st Preference resource
Pre-workshop (%)
Post-workshop (%)
Discussion
Attendees responded positively to the sessions. Students stated that it was helpful to have this session delivered by other students, who were able to supplement the sessions
with anecdotes of how they have found EBM useful in clinical placements. In addition, the workshop facilitators emphasised t he role EBM plays in future assignments, such as
s t u d e n t s e l e c t e d c o m p o n e n t s , c r i t i c a l a p p r a i s a l a n d c a s e r e p o r t s . A s s e s s m e n t i s k n o w n t o d r i v e l e a r n i n g 6, a n d r e l a t i n g t h e s e s s i o n s t o f u t u r e a s s e s s m e n t e n c o u r a g e d s t u d e n t s
to participate actively in the workshops.
At Keele School of Medicine, students are taught EBM progressively each year through repeated sessions in the spiral curricul um. Students generally have a good understanding
of the methods for accessing high -quality evidence-based guidelines but often revert to the information that is most easily acce ssed via general internet search engines such as
‘ G o o g l e ’ 7. We a n t i c i p a t e t h a t a n e a r l y i n t e r v e n t i o n i n y e a r 1 , f o l l o w e d b y r e i n f o r c e m e n t i n s u b s e q u e n t y e a r s , w i l l p r o m o t e s u s t a i n e d u s e o f N I C E E v i d e n c e S e a r c h .
Conclusion
Whilst many students were aware of evidence -based resources, they tended not to use them as their preferred source. The worksho ps were effective in promoting the use of
NICE Evidence Search as a tool for accessing evidence -based resources.. The workshops were received well by students with one s tudent commenting, “due to the vast array of
material available online, it is good to have a resource which you know can be trusted and provides concise, relevant informa tion”.
References
1. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: What it is and what it isn't. BMJ. 1996;312(7023):71-72.
2. Ilic D, Forbes K. Undergraduate medical student perceptions and use of evidence based medicine: A qualitative study. BMC Med Educ. 2010;10:58-58.
3. Cayley,William E.,,Jr. Evidence-based medicine for medical students: Introducing EBM in a primary care rotation. WMJ. 2005;104(3):34-37.
4. NICE. NHS Evidence Search. http://www.evidence.nhs.uk/. Updated 2013. Accessed 25/07, 2013.
5. NICE Evidence Search Student Champion Scheme http://www.nice.org.uk/getinvolved/studentchampions/StudentChampions.jsp Accessed 25/07/2013
6 Raupach T, Brown J, Anders S, Hasenfuss G, Harendza S. Summative assessments are more powerful drivers of student learning than resource intensive teaching formats. BMC Med. 2013;11:61.
7.Duran-Nelson A, Gladding S, Beattie J, Nixon LJ. Should we Google it? Resource Use by Internal Medicine Residents for Point-of-Care Clinical Decision Making. Academic Medicine. 2013;88(6):788794
KMES
Keele Medical Education Society