Course Syllabus ©National College of Midwifery 2013
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Course Title: BSM MW460-Introduction to Evidence Based Practice in Midwifery Care
Course Credit: 4
Course Description: This course builds on the concepts covered in the course
Introduction to midwifery research methodologies. Students learn to analyze and
understand research and medical literature through the development of critical appraisal
skills. In this course the area between research and practice is bridged giving students
practical tools for problem-solving clinical questions and converting research into
practice.
Course Objectives: After completing this course students will:
 Understand how to effectively read scientific literature
 Understand how to use available tools to analyze the efficacy of a study design
 Be able to evaluate a study for its rigor and quality
 Be familiar with the peer review process required for publication
 Understand the significance of a systematic research review
 Understand how to turn clinical problems into research questions
 Be able to critically appraise systematic reviews
 Be able to present research on a research question so that it can be understood
by the wider clinical community
Learning Materials / Resources:
Please use textbooks less than 5 years old or most recent edition.
1.
(Online Resource) CASP: Critical Appraisal Skills Programme checklists.
http://www.casp-uk.net/
2.
(Online Resource) BioMed Central Pregnancy and Childbirth.
http://www.biomedcentral.com/bmcpregnancychildbirth/
3.
(Textbook) Jirojwong, S et al. Research Methods in Nursing and Midwifery:
Pathways to evidence-based practice. Oxford University Press. 2011
4.
(File Downloadable from NCM website) Cluett, Elizabeth. “Chapter 2:
Evidence Based Practice”. Principles and Practice of Research in Midwifery.
2nd edition. Churchill Livingstone Elsevier. 2006
5.
(File Downloadable from NCM website) Redshaw M, Henderson J. Learning
the hard way: expectations and experiences of infant feeding support. Birth.
2012 Mar;39(1):21-9. doi: 10.1111/j.1523-536X.2011.00509.x. Epub 2012 Jan
9. PubMed PMID: 22369602.
6.
(File Downloadable from NCM website) Saastad E, Winje BA, Israel P, Frøen
JF. Fetal movement counting--maternal concern and experiences: a
Course Syllabus ©National College of Midwifery 2013
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multicenter, randomized, controlled trial. Birth. 2012 Mar;39(1):10-20. doi:
10.1111/j.1523-536X.2011.00508.x. Epub 2012 Jan 9. PubMed PMID:
22369601.
7.
(Online Resource) SUNY DOWNSTATE MEDICAL CENTER EVIDENCE
BASED MEDICINE TUTORIAL. Suny Downstate Medical Center. 2004.
http://library.downstate.edu/EBM2/contents.htm
8.
(File Downloadable from NCM website)Tutorial: How to Form an Answerable
Clinical Question. Cincinnati Children’s Hospital Clinical effectiveness
specialist. 2004.
9.
(File Downloadable from NCM website) Abalos E, Carroli G, Mackey ME,
Bergel E. Critical appraisal of systematic reviews: The WHO Reproductive
Health Library, No 4, Geneva, The World Health Organization, 2001
(WHO/RHR/01.6).
10.
(File Downloadable from NCM website) Wax JR, Lucas FL, Lamont M, et al.
Maternal and newborn outcomes in planned home birth vs. planned hospital
births: a meta analysis. Am J Obstet Gynecol 2010; 203:243.e1-8. Wax JR,
Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home
birth vs. planned hospital births: a metaanalysis. Am J Obstet Gynecol
2010;203:243.e1-8.
11.
(File Downloadable from NCM website) Buckman, et al. Evidence Based
Medicine: A Mini-manual. University of Alberta. 2008
A note about the textbook:
As is made obvious by the title of the main text used for this course, it is based in a
perspective of hospital-based midwifery and references the field of nursing extensively.
Unfortunately, the field of direct-entry midwifery research in the US is still in the early
stages of development, therefore we have no academic texts that reflect the principles
and values of our own profession within the field of research. This text was chosen
because it is accessible and written for teachers and learners. Please bear in mind that
although it may not always speak directly to midwifery practice the concepts provided
can, in most cases, be applied to research in the field of midwifery.
Please also note that the resources numbered 7,8, and 11 are accessory resources.
These resources go beyond the scope of the primary text and are meant to supplement
learning for those students who are interested. These resources are more in-depth then
the basic concepts that are required for this course. Please use them with the
understanding that they may go beyond the scope of this course in detail and
complexity.
Learning Activities:
(See Course Assignments)
Course Syllabus ©National College of Midwifery 2013
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Student reads appropriate sections from the Learning Materials/Resources.
Student evaluates research and scenarios.
Student answers questions.
Student writes critical reviews.
Student creates posters and charts.
Student presents work.
Evaluation Tools / Methods:
Minimum passing grade for all courses is a cumulative 80% / B-. Students and
preceptors are encouraged to work together until the student masters 100% of the
information.
Evaluation is based on demonstration of comprehension of concepts and completion of
written assignments. The preceptor will evaluate the written activities for each lesson for
completeness, comprehension, and professional presentation. Answers should be
referenced when appropriate and written work should be typed and well organized.
Lesson 8 is culmination of the competencies learned in this course, therefore it should
be graded as 40% of the students’ final grade. This course is graded on a pass/fail
scale. The student must achieve a grade of at least 80% to pass.
Course credit:
One Academic credit equals approximately 15 hours of formal time plus 30 hours of
additional study or homework. Formal time is defined as the amount of time taken to
answer the Learning Objectives to the level of 80% and to complete any learning
activities to the preceptor's satisfaction, including any time spent face to face with the
preceptor. Informal time includes any time spent actively reading relevant sources and
textbook/s, researching Learning Objectives, and studying for examinations.
Portfolio requirement: In order to complete the BSM program the student must upload
select assignments that have been completed and graded by the preceptor onto a
dropbox.com account for final review by College staff.
The required assignments for this course are:
1. Lesson 6-2 Clinical scenarios,
2. Lesson 6-3 PICO question chart,
3. Lesson 7-2 Critical appraisal,
4. Lesson 8 Mini-review and poster.
Course Assignments:
Reading and writing assignments are to be completed by the student with supervision of
the preceptor. Read each chapter or article carefully and follow the directions outlined in
the lessons. Focus on learning the key concepts and terminology of each lesson before
answering the questions or completing assignments. We encourage students to spend
Course Syllabus ©National College of Midwifery 2013
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time reviewing these concepts with the preceptor to ensure that each is well
understood.
Lesson 1: Read Chapter 13: Critical Review of Research
1. Discuss the skill sets that are helpful to employ in the reading of the scientific
literature when preparing for a systematic review.
2. Discuss the importance of evaluating the quantity and general quality of the
research available on a given topic before beginning a full review.
3. What are some ways that students can become familiar with the process of
critical review?
4. What are some critical appraisal tools that are used to critique literature?
5. Discuss some ways the entry-level researcher can critically appraise the
statistical portion of a study without extensive knowledge of statistics.
6. Discuss the sections of a critical appraisal. Name each section and briefly
describe what will be talked about in that section.
7. How is graphing or diagraming concepts important to a critical appraisal?
8. What are the areas in which you should be able to discuss the available research
on a given topic after having completed a critical appraisal?
Lesson 2: Read the article Fetal Movement Counting—Maternal Concern
and Experiences: A Multicenter, Randomized, Controlled Trial.
1. Skim the article first, reading for general impressions and conclusions.
2. Read the article a second time, taking notes and writing down questions that you
may have.
3. Make a list of words in the article that you do not fully understand—whether they
are research terms or clinical terms. Research definitions for these terms and
create a glossary for your use.
4. Choose which CASP worksheet (see resources) best addresses this study.
5. Fill out the CASP worksheet
6. Write up a brief summery of your findings from the CASP worksheet.
7. Discuss the article with your preceptor and give a synopsis of the implications
the article might have for clinical practice.
Lesson 3: Read article Learning the Hard Way: Expectations and
Experiences of Infant Feeding Support
1. Evaluate the article by briefly answering the following questions:
a. Is the article clearly headed and named?
b. Are the researchers qualifications and affiliations provided?
c. Does the title reflect the study designs, topic and finding?
d. Does the abstract give concise picture of the research?
e. Is the purpose of the study clearly articulated?
f. What is the research question?
g. Is the literature review extensive?
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Does the literature review reflect current sources?
Is the literature review critical and unbiased?
Do the authors acknowledge any bias or conflicts of interest?
Has a conceptual framework been identified and if so is it applicable to the
study?
Has the conceptual framework influenced or biased the study findings?
Could the study be replicated from the description of sampling and data
analysis that is provided?
Is the sampling method and size adequate?
Does the study discuss whether it was reviewed by an ethics committee?
Does the study mention informed consent?
Have the participants been informed about how confidentiality was
handled in the study?
Are the findings of the study clear?
Has the research question been answered?
Are the implications of the research findings discussed? How?
Is the citation of the literature consistent and adequate?
Lesson 4: Familiarization with peer review process
1.
Access the website for the open-access journal BMC- pregnancy and
childbirth at http://www.biomedcentral.com/bmcpregnancychildbirth/ or by
searching in Google.
2.
Select an article of interest to you about a topic relating to maternal/child
health or childbirth.
3.
Read the article in following steps 1-3 listed in lesson 2.
4.
Write notes about any issues or questions that come up during your reading.
5.
Review the area titled “pre-publication history” located in the side-bar menu
next to the article
6.
Carefully review the criticisms that were given to the author(s) of the article
and the changes that were made before final publication.
7.
Write notes about the peer-review process and discuss these along with any
other questions or issues that you observed about the article with your
preceptor.
Lesson 5: Read Chapter 14: Undertaking a systematic review in Research Methods in
Nursing and Midwifery and Evidence based practice by Elizabeth Cluett
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Why are systematic reviews considered the highest forms of evidence?
What are some of the ways that systematic reviews impact policy
development?
Discuss the steps in developing a protocol for a systematic review.
Why is it important to develop a good research question for a systematic
review?
Describe PICO research question framework.
How does a PICO question influence the inclusion of studies in a review?
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Describe a good approach to a comprehensive search of the literature on a
given topic. Where should a researcher look to find as much research on a
given topic as possible?
Describe ways to document a search strategy so that others might replicate
that search if needed.
Discuss effective ways to search electronic research databases.
What is grey literature?
How can a researcher access grey literature?
How are studies included or excluded from a review after the comprehensive
search phase?
Describe what is meant by data extraction.
Describe the use of summary tables in presenting data.
Discuss the significance of a meta-analysis.
Briefly discuss how a meta-synthesis of qualitative data is carried out.
Where are systematic reviews often published?
Lesson 6: Creating a PICO question
1. Read the tutorial How to form an answerable clinical question and take notes.
2. (Upload to Portfolio) Generate three clinical scenarios from your own practice
that have lead you to question what advice or treatment you should give a client.
3. (Upload to Portfolio)Create a chart for each of the clinical scenarios that
answers the follow questions:
a. What is your clinical question in PICO format?
b. What type of clinical question is it?
c. What is the best study design for answering this question?
Note: The SUNY Downstate medical Center Evidence Based Medicine tutorial may be
helpful to you for this section.
Lesson 7: Critical appraisal of a systematic review
Read the critical appraisal of systematic reviews guide from the WHO library.
1.
Using the WHO guide conduct a critical appraisal of the Wax et al article on
Planned homebirth vs. hospital birth listed in the resource section.
2.
(Upload to Portfolio)Write up your critical appraisal following the guidelines
and drawing on the textbook and other resources listed in the resource
section.
3.
After your critical appraisal is finished, do a search for critical discussion of
the Wax et al article and compare this discussion to your critical appraisal
with your preceptor.
Lesson 8: Evidence Based Practice Poster project
(Upload to Portfolio: Mini-review and poster.)
1.
Using one of your PICO questions perform a mini-review and present it as a
poster presentation following these guidelines:
Course Syllabus ©National College of Midwifery 2013
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a. State the Pico question and give a short description of problem and its
significance.
b. Perform a critical appraisal of 3-5 studies related directly to your PICO
question.
c. Present a synopsis of this critical appraisal in your poster including: article
citations, level of evidence of the study, conclusions drawn by the study,
relevance of the study to your PICO question, and any significant research
flaws in the study.
d. Synthesize recommendations for clinical practice (if any) that can be
created based on the studies that have been analyzed. Illustrate areas
where evidence is not conclusive for creating practice recommendations.
e. Organize the poster in a way that is professional, attractive and easy to
read. Provide drawings or pictures where necessary for clarification. (For
example of poster formatting you can reference the Natural Sciences
Guidelines for undergraduate research conference: guidelines for poster
presentations http://www.pitt.edu/~etbell/nsurg/PosterGuide.html or The
Vanderbilt University Medical Center Evidence Based Practice and
nursing research resources on poster presentations
www.mc.vanderbilt.edu/root/vumc.php?site=evidencebasedpractice&doc=
37886
f. Write a 350 word abstract for the poster that provides introductory
information on the research review and implications for clinical practice.
g. Present this poster project to your local midwifery group or fellow
midwifery students along with the abstract and solicit feedback and
questions.