ASSISTANT PROFESSOR/PHD STUDENT
FACULTY OF HEALTH AND SOCIAL SCIENCES,
CENTRE FOR EVIDENCE BASED PRACTICE/ DEPARTMENT OF OCCUPATIONAL THERAPY,
PHYSIOTHERAPY AND RADIOGRAPHY, BERGEN UNIVERSITY COLLEGE
Implementation of
evidence-based practice
in education
Nina Rydland Olsen
Why heat for
my neck
pain?
http://www.ablebody.ca/wpcontent/uploads/2012/04/Neck-2.jpg
Shared decision making (SDM)1
http://www.wikihow.com/Treat-Neck-and-BackPain-Naturally
1Chewning,
B., Bylund, C. L., Shah, B., Arora, N. K., Gueguen, J. A., & Makoul, G. (2012). Patient preferences for shared decisions: A systematic review. Patient Education
and Counseling, 86(1), 9-18. doi: http://dx.doi.org/10.1016/j.pec.2011.02.004
1http://sdm.rightcare.nhs.uk/
1Swennen,
Colleagues is a preferred source of evidence
M. H., van der Heijden, G. J., Boeije, H. R., van Rheenen, N., Verheul, F. J., van der Graaf, Y., & Kalkman, C. J. (2013). Doctors' perceptions and use of evidence-based medicine: a
systematic review and thematic synthesis of qualitative studies. Acad Med, 88(9), 1384-1396. doi: 10.1097/ACM.0b013e31829ed3cc
2Ubbink, D. T., Guyatt, G. H., & Vermeulen, H. (2013). Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open, 3(1). doi:
10.1136/bmjopen-2012-001881
3Rappolt S, Tassone M: How rehabilitation therapists gather, evaluate, and implement new knowledge. J Contin Educ Health Prof 2002, 22(3):170–180.
4 Estabrooks CA, Scott-Findlay S, Winther C: A Nursing and Allied Health Sciences Perspective on Knowledge Utilization. In Using Knowledge and Evidence in Health Care. Edited by LemieuxCharles L, Champagne F. Toronto: University of Toronto Press; 2004:242–280.
Topics
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What is EBP
EBP curriculum
EBP tools
Faculty development
EBP role models
Patient
values and
experience
Context
Evidencebased
Practice
Current best
evidence
Clinical
expertise
Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J. Sicily statement on evidence-based practice. BMC Medical
Education 2005; 5: 1.
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71-72.
Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9: e86706.
Evidence-based Practice (EBP)
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Systematic approach
Caring for patients creates a need for research evidence
Life long learning
A shift from fact memorization to critical reasoning
Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9: e86706.
6
https://www.flickr.com/photos/teegardin/5860234733/sizes/l/
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., . . . Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an
interdependent world. Lancet, 376(9756), 1923-1958. doi: 10.1016/S0140-6736(10)61854-5
World Health Organization (2004). World Report on Knowledge for Better Health: Strengthening Health Systems.
http://www.who.int/rpc/meetings/world_report_on_knowledge_for_better_health.pdf?ua=1
7
Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, et al. (2005) Sicily statement on evidence-based practice. BMC Med Educ 5: 1.
Not just a research course…
• EBP teaching: previously emphasised critically appraising
research.
• Sicily statement: curricula based on the “5 step model”
› ASK, FIND, APPRAISE, APPLY/INTEGRATE, EVALUATE
Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R., & Stewart, R. (2011). Teaching critical appraisal skills in healthcare settings. Cochrane
Database Syst Rev(11), CD001270. doi: 10.1002/14651858.CD001270.pub2
Pourtney, L. G. (2004). Evidence-based practice and clinical decision making: it's not just the research course anymore. Journal of Physical
Therapy Education, 18(3), 46-51.
EBP curriculum
• Structure within the larger curriculum vary:
› Stand-alone courses
› Clinical courses
› Mixed approaches
Lewis, L. K. (2010). Evidence based practice in physiotherapy entry-level education. (Doctoral thesis), University of South Australia Adelaide.
Meats, E., Heneghan, C., Crilly, M., & Glasziou, P. (2009). Evidence-based medicine teaching in UK medical schools. Med Teach, 31(4), 332-337.
doi: 10.1080/01421590802572791
Blanco et al. 2014 .
Different ways:
Lectures
Workshops (e.g. CASP)
Journal clubs
Patient reports
Assignments
Group work
Exams
Bed-side teaching
Etc.
EBP in clinical education
• Role modelling
• Use research evidence when teaching
• Teach specific EBP skills
Straus, S. E., & Sackett, D. L. (2005). Evidence-based medicine: how to practice and teach EBM (3rd ed.). Edinburgh:
Elsevier Churchill Livingstone.
Evidence-based delivery format?
• Face-to-face vs online
• Active learning vs traditional lecturing1
• Learning in groups (e.g. problem based learning, team-based)
• The Best Evidence Medical Education (BEME) Collaboration:
› The development of evidence informed education in the medical and health
professions: http://www.bemecollaboration.org/
1Freeman,
S., Eddy, S. L., McDonough, M., Smith, M. K., Okoroafor, N., Jordt, H., & Wenderoth, M. P. (2014). Active learning increases student performance in science,
engineering, and mathematics. Proceedings of the National Academy of Sciences, 111(23), 8410-8415. doi: 10.1073/pnas.1319030111
Effectiveness of EBP teaching
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Multifaceted teaching strategies
Clinically integrated
Involve assessment
Interactive
Khan, K. S., & Coomarasamy, A. (2006). A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine. BMC Medical Education, 6, 59.
Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9: e86706.
How to describe educational interventions
Phillips, A., Lewis, L., McEvoy, M., Galipeau, J., Glasziou, P., Hammick, M., . . . Williams, M. (2014). A systematic review of how studies describe educational
interventions for evidence-based practice: stage 1 of the development of a reporting guideline. BMC Medical Education, 14(1), 152.
EBP learning outcomes
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Reaction
Self-efficacy
Attitudes/ beliefs
Knowledge
Skills
Behaviour
Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C, Green M. Instruments for evaluating education in evidence-based practice: a
systematic review. JAMA 2006; 296: 1116-27.
Tilson JK, Kaplan SL, Harris JL, Hutchinson A, Ilic D, Niederman R, Potomkova J, Zwolsman SE. Sicily statement on classification and development of
evidence-based practice learning assessment tools. BMC Medical Education 2011; 11: 78.
EBP across the curriculum
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When? (timing)
What? (content)
How? (delivery format)
Where? (setting)
How much? (amount, hours)
Olsen et al. 2014, Mc Evoy et al. 2010, McEvoy et al. 2011
EBP tools
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EBP steps
Clinical questions
PICO
EBP resources (databases, pre-appraised evidence)
EBP learning tools (e.g. portfolios, CATs)
etc.
EBP steps
5. Evaluate
4. Integrate
1. Ask
2.Search
3. Appraise
Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K., . . . Osborne, J. (2005). Sicily statement on evidence-based practice. BMC Medical Education, 5(1), 1.
Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71-72.
Clinical questions
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Effects of intervention
Patient experiences
The course of the condition (prognosis)
The accuracy of diagnostic tests (diagnosis)
What is the cause of this problem (aetiology)
Guide the literature search
PART I
PART II
Need for expert teachers in EBP
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Insufficient education on EBP: a potential barrier
Teachers need:
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EBP skills and knowledge
Skills and courage(?) to teach EBP
Lack of role models
• Lack role models with strong skills in EBP
• CIs need training in EBP
• Lack of support
Florin et al. 2012
Why do students struggle to apply EBP?
Olsen, N. R., Bradley, P., Lomborg, K., & Nortvedt, M. W. (2013). Evidence based practice in clinical physiotherapy education: a qualitative
interpretive description. BMC Medical Education, 13(1), 52. doi: 10.1186/1472-6920-13-52
National
and local
agreement
Current
best
evidence on
teaching
EBP across
curriculum
EBP in
education
EBP role
models
Expert
teachers
Defined
learning
outcomes
Assessment
Motivated
students