DEPARTMENT OF PUBLIC HEALTH MEDICINE

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ACADEMIC PROGRAMME: JOURNAL CLUB

2022

Dr LB Mashao

Article under discussion:

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students.

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Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

Panelists

• Chairperson- Dr Molapane Chueu
• Presenter- Dr Lehlohonolo Mashao
• Author- Dr Tippawan Liabsuetrakul
• Closing Person- Dr John Mathabathe

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Contributors of Article

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

• Tippawan Liabsuetrakul MD PhD- Associate Professor, Epidemiology Unit, Prince of Songkla University
• Thanitha Sirirak MD- Family Physician, Instructor, Department of Community Medicine, Prince of Songkla University
• Sathana Boonyapipat MD- Assistant Professor, Department of Obstetrics and Gynecology, Prince of Songkla University
• Panumad Pornsawat BBA-Division of Medical Education, Faculty of Medicine, Prince of Songkla University

Objective

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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To assess how the

1. knowledge
2. attitude
3. skill

of medical students is effected by integrating evidence-based medicine (EBM) into a medical curriculum in the form of small-group discussions with the use of case scenarios and problem-based learning.

Background

• Evidence based medicine→ Integrating medical research evidence into clinical practice with patient’s preferences and values in mind
• Deciphering what clinical evidence best serves and satisfies the formulated clinical question=Clinical problem
• Studies show that the more we are taught “appraisal skills” the better we are in our research methods and skills and the better our outlook on medical literature
• Continuous monitoring of these skills knowledge and attitudes is important in upholding the value of the programme

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Origins of our study

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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The need to find the best approach of teaching evidence medicine still remains!

Background continued

• Medical faculty of the Prince of Songkla University(1972) – integrated EBM practice teaching in 2005 in the clinical years of the 6 year curriculum with the use of small group discussions and problem based learning
• The inclusion of introductory case scenarios was used to supplement the clinical inexperience of lower year students(fourth years)
• This study seeks to show us what effect continuous teaching (particularly with the above mentioned approach) of EBM practice in medical curriculum has on students’ knowledge skills and attitude

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Methods Utilised

• Quasi-experimental(Quantitative) study conducted at the Prince of Songkla University, Thailand. (2008-2009)
• Population group- medical students (end of fourth year of study into fifth year)

- mean age 22.1 years old

-114 participants

- 50% female

• 37 week(~10 month) period

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Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Method continued

• Application of the 5 steps of EBM in the form of
• Case Scenarios (fourth year study)
• Self practice- learner-centred

-problem-based (fifth year study)

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• Small group discussions

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Method continued

• EBM practice course
• formulating a clinical question (ASK)
• searching for evidence (ACQUIRE)
• critically appraising the evidence (APPRAISE)
• integrating the evidence into practice (APPLY)
• Evaluating and monitoring the evidence (ASSESS)

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Method

Fourth years’ Course

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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• Discussion groups : 3 groups(12-15 students) →5 groups (2-3 students)
• Facilitation by members of the EBM group from different medical specialties using a facilitators guidance module

Method

Fifth Years’ Course

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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• Learner-centred- Formulate questions based on individual interests

- Acquire their own articles

-Research evidence

- Integrate EBM into clinical practice by comparing research

findings with observed clinical practices

• Monitoring of students’ understanding and progress at 12 week intervals in small group discussions

Method

• Evaluating Course Outcome

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Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Knowledge

• Summative Assessment in the form pre-test and post- test case scenarios
• 8 Items on EBM principles assessed (each with score 0-8)

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Attitude

• Self assessment
• 5 Items based on course’s learning objectives
• Quality of evidence
• Need for evidence and need for EBM teaching in clinical practice

Skill

• 5 Item Self assessment of ability to :
• Apply EBM principles
• Differentiate between foreground and background questions

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Results

• Knowledge-paired t-test
• Attitude and Skill- Cronbachs’ alpha

-5point rating scale-Avg score

-scores analysed by linear

mixed effects model

• p value < 0.05 = statistical significance

Data Analysis

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Results

Knowledge

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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• Increase from 4 to 54% of students who got full scores after the EBM learning course.

Results

Attitude and Skill

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

• Cronbachs Alpha= 0.92= Reliable
• T0 -Attitude 3.32 (0.93)

-Skill 2.55 (0.79)

• Mean score for attitude lower in fifth years than fourth years:

(4.06 versus 4.21,P = 0.002)

• Mean scores for skill with insignificant difference

(3.88 versus 3.94, P = 0.17)

• Both attitudes and skills at any time after learning EBM (T1 to T5) increased significantly from T0 (P < 0.001).

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Results

Attitude and Skill

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

• Lower scores at T2 and T3 when compared to T1
• Improvement of both skills and attitude at T4 during fifth year learning course(more clearly displayed on graph)

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Discussion

• Summative assessment which was used to measure the outcome of the study showed that including small group discussions had significantly improved the knowledge students have of evidence based medicine and its application
• Case Scenarios can impact student attitude and skills and even more so when coupled with self practice and small group discussions
• Self-directed learning however, as well as problem based learning may have the disadvantage of being less effective than traditional teaching programmes if not executed well.

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Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Discussion

• There is still a question of what the best approach to teaching medical students evidence based medicine is
• At the time the study was conducted:
• Prince Songkla University’s medical faculty→ small group discussions; case scenarios and problem based learning guided by the cognitive load theory

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Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Discussion

• Facilitators of different approaches and varying skill levels→ facilitators guidance module
• Short term evaluation without follow up of long term effect particularly in clinical settings

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Limitations

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Discussion

• Students reported themselves increased knowledge and improved skill and attitude following the EBM course(shown in both subjective self report and objective assessment)
• Consistent findings in other studies of the same nature

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What the participants had to say

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Continuity of teaching enhances long term learning

Discussion

• Different strokes for different folks-Modify training to student

BUT

• Ideal to maintain the 5 step approach to EBM as framework for practicing knowledge and skills
• Balance between independent learning and assisted learning
• Continuous training is best

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Conclusion

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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References

• Liabsuetrakul, T., Sirirak, T., Boonyapipat, S., & Pornsawat, P. (2012). Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. Journal Of Evaluation In Clinical Practice, 19(4), 607-611. doi: 10.1111/j.1365-2753.2012.01828.x
• Liabsuetrakul, T., Suntharasaj, T., Tangtrakulwanich, B. & Pornsawat,P. (2009) Longitudinal analysis of integrating evidence-based medicine into a medical student curriculum. Family Medicine, 41, 585588.

Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Effect of continuous education for evidence-based medicine practice on knowledge, attitudes and skills of medical students. 26/04/2022

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Thank You