Higher Education and Professional Books. Medical and Nursing Books. Enter pincode. Usually delivered in 2 weeks? VictoryTradiN 2. Do you want to improve standards of practice? Metrics details. While a variety of instruments have been developed to assess knowledge and skills in evidence based medicine EBM , few assess all aspects of EBM - including knowledge, skills attitudes and behaviour - or have been psychometrically evaluated. Construct validity, item difficulty, internal reliability and item discrimination were analysed.
A statistically significant difference in the total ACE score was observed and corresponded to the level of training: on a point test, the mean ACE scores were 8. Individual item discrimination was excellent Item Discrimination Index ranging from 0. To provide a complete suite of instruments to assess EBM competency across various patient scenarios, future refinement of the ACE instrument should include further scenarios across harm, diagnosis and prognosis.
Evidence based medicine EBM is now well established as a discipline across a variety of medical, allied and health sciences curricula. EBM provides users with the ability to integrate evidence into decision making alongside clinical expertise and patient values [ 1 ]. EBM integrates knowledge and skills from a variety of sub-disciplines including clinical epidemiology, information literacy, knowledge management and biostatistics. In the Sicily statement on classification and development of evidence-based practice learning assessment tools was developed [ 3 ]. The classification rubric for EBP assessment tools in education CREATE provides guidance when developing new EBM-related assessments by classifying assessment categories reaction to educational experience, attitudes, self-efficacy, knowledge, skills, behaviours and benefit to patients and types self-report, cognitive testing, performance assessment, activity monitoring and patient orientated outcomes with the five EBM steps [ 3 ].
Conversely, active monitoring and patient-orientated outcomes are believed to best assess EBM behaviour and benefit to patients [ 3 ]. EBM related knowledge and skills are the only assessment categories that are best examined via performance, or cognitive, assessment [ 3 ]. A variety of instruments have been developed to assess competency in EBM. Few instruments have been developed to assess all aspects of EBM, including knowledge, skills attitudes and behaviour, or been psychometrically evaluated.
The Fresno test [ 5 ] and the Berlin Questionnaire [ 6 ] represent the only two instruments developed to date that assess knowledge and skills across 3 of the 5 EBM steps ask, acquire and appraise [ 3 ].
It provides users with a choice of two clinical scenarios, of which users are required to choose one in order to answer 12 open-ended questions. The original Fresno test has been adapted for use in other health disciplines including physical and occupational therapy with acceptable reliability and validity [ 7 , 8 ]. The Berlin Questionnaire was designed to measure deep learning, with the emphasis on the application of existing EBM knowledge and skills [ 6 ]. The Berlin Questionnaire has not been adapted for use in disciplines other than medicine [ 10 ].
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Both the Berlin Questionnaire and the Fresno test along with its adaptions are classified as the only level 1 instruments currently with the ability to assess competency in EBM [ 4 ]. Level 1 instruments are defined as those that have robust psychometric properties and have the ability to discriminate between different EBM levels, or expertise [ 4 ].
As level 1 instruments, the Fresno test and Berlin Questionnaire have the ability to discriminate between different levels of expertise across users, possess robust psychometric properties and examine skills and knowledge that users would require in undertaking a realistic task related to practising EBM [ 4 , 10 ]. Training in EBM has become commonplace across medical curricula worldwide [ 11 ]. Multiple choice questions MCQs , extended matching questions EMQs , critical appraisal topics, essays and objective structured clinical examinations OSCEs are all forms of assessment that may examine, to a certain degree, learner competency in EBM [ 12 — 14 ].
None of the above mentioned modes of assessment have been developed and validated to specifically assess EBM competency in medical trainees. Both the Berlin Questionnaire and Fresno test are limited in their ability to measure EBM competency within a medical curricula. Neither instrument has been validated in a sample of medical trainees.
Conversely, the Berlin Questionnaire can generally be completed within 15—20 minutes, and poses a smaller burden on time regarding grading due to use of 15 MCQs. Significantly, neither of these level 1 instruments examines competency across all 5 EBM steps. The fifth step of the EBM process is evaluation, which has been suggested is best assessed through observation [ 3 ].
The ACE tool presents users with a short patient scenario from which a clinical question is derived. Users are then presented with a search strategy designed to identify a randomised controlled trial and a hypothetical article extract. Users are required to work through 15 questions answering yes or no , with each question representing one of the four steps of EBM formulation of the clinical question, search of the literature, critical appraisal and application of the evidence to the patient Additional file 1. Items 1—11 assess knowledge and skills relevant to EBM, whilst items 12—15 assess attitudes relevant to the implementation of EBM in clinical practice.
DI developed the initial version of the ACE, with the remaining four authors modifying the tool to ensure that all steps of the EBM process were adequately addressed.
Assessing Interprofessional Interactions of Primary Care Practitioner Trainees
The 15 items assess four of the steps associated with EBM — the exception being the last step of evaluation. Items 1 and 2 relate to step 1 asking the answerable question , items 3 and 4 relate to step 2 searching the literature , items 5—11 relate to step 3 critical appraisal and items 12—15 relate to step 4 applying the evidence to the patient scenario. A variety of the items were based on existing critical appraisal templates and modified accordingly for the development of the ACE tool [ 15 , 16 ]. Content and face validity of the ACE tool was established through an iterative process by consensus expert opinion [ 17 ].
A cross-sectional, convenience sample of medical trainees from Monash University participated in the study. Three trainee cohorts were recruited to represent different levels of EBM competency. Item Mean The objectives of the course were shared at the start of the elective. Further data is needed in order to demonstrate a statistically significant increase in resilience and personal accomplishment. Appendices None. Declarations There are no conflicts of interest. All work was carried out in accordance with the Declaration of Helsinki and there was no potential harm to participants.
All students were provided and signed a School of Medicine consent form stating they understood that their responses were anonymous, and any course evaluation data would be used only in de-identified aggregate form. External Funding This paper has not had any External Funding. The concept of a humanities-based course is also quite fitting for medical students who become overwhelmed during the basic sciences and not only seek reprieve but new strategies for success.
As physicians are expected to be lifelong learners, I think that reflection and self-assessment should be integrated throughout the entire medical education curriculum from the first year. This an interesting study and I would be curious to see the results if the study was reproduced with a larger cohort of medical students.
View Replies 1. As someone very interested in the role of the humanities in medical education, I looked forward to reviewing this paper. Although it was written very clearly and it is interesting to hear of the courses that the medical school is applying, I sadly remain very indifferent to the strong statements that the authors have drawn from this paper. I have no doubt that the course was interesting, they often are to medical students frequently swamped with too much basic sciences information and the need to grasp very difficult new learning- this course must have sounded different and exciting and of course quite acceptable given that they could even miss out a large proportion of it without fear or consequence.
So I was not surprised with the positive post-course evaluation. However, it lies at only level 1 Kirkpatrick and I think for this paper there should have been a rise in this level to at least level 3- which of course would add a time element to the evaluation process. I was not sure why, if it was a structured course, hopefully designed to match some learning objectives, how such a large element could be missing- was there a strong repetitive element?.
I would also worry about the numbers , given the small number who completed both questionnaires in the second cohort. I might have been more convinced if a greater emphasis was placed on the qualitative element of the evaluation. In the references, specifically to resilience, I was surprised not to see any references to Wald et al. My main worry however is in how the authors have interpreted this data in such a strong fashion. Can we really say so strongly, as the authors have in their first two take home messages, that such a positive effect is gained through such a course, is their not a time element in this, should we not wait until the students are exposed to those activities that cause burn-out and expose their ability to be resilient in the face of many forms of difficulty?
As I mentioned before, I am not at odds with what sounds an exciting humanities course, more in conflict as to what we can positively gain from such an evaluation and how we value the strength of such an evaluation. View Replies 2.
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This is a well researched and presented piece of work. It reads easily and is understandable. The subject matter is very topical, both the burnout seen in medical undergraduates but also humanities in medicine. What is an additional concern is the students scored so highly in emotional exhaustion, consistent with other studies. As a piece of work it reinforces the fact that the humanities are so important, which is why the composition of the sessions would be really helpful. View Replies 3. Views Average Rating 3. Recommended Not Yet.
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