An evidence-based medicine curriculum implemented in journal club improves resident performance on the Fresno test

J Emerg Med. 2015 Feb;48(2):222-229.e1. doi: 10.1016/j.jemermed.2014.09.011. Epub 2014 Nov 1.


Background: Journal club is a standard component of residency education. Journal club focuses on review and interpretation of the medical literature with varying degrees of evidence-based medicine (EBM) education.

Objectives: To evaluate learning of EBM principles with an EBM curriculum implemented as a component of journal club. EBM competency was established using the Fresno test, a validated 12-question instrument of short-answer and essay-style questions to assess competency in EBM.

Methods: An EBM curriculum was implemented that consisted of a focus on EBM topics (e.g., study validity, bias, confidence intervals, search strategies) using a structured journal club format using a peer instruction model. The Fresno test was used prior to and after the implementation of the first year of this curriculum to measure effectiveness of the intervention. A hierarchical multivariable model using generalized estimating equations was used to account for repeated measures in the primary outcome of change in total Fresno test score.

Results: The total test scores did not increase significantly (105.4 vs. 120.9, p = 0.058) in the before-after analysis. The only subscore showing improvement was interpretation of study validity (32.1 vs. 40.4 points, p = 0.03). Attendance was significantly associated with Fresno test score, with those attending ≥ 6/11 sessions (55%) scoring 28.2 points higher (p = 0.003), and those attending fewer than six sessions scoring only 1.9 points higher (p = 0.81) than in the preintervention group.

Conclusion: An EBM curriculum implemented as part of journal club improves performance on the Fresno test among residents who attended at least six journal club sessions.

Keywords: Fresno test; education; educational measurement; evidence-based medicine; internship and residency; medical.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Competence
  • Cross-Sectional Studies
  • Curriculum*
  • Education, Medical, Graduate / methods*
  • Educational Measurement / methods
  • Emergency Medicine / education*
  • Evidence-Based Medicine / education*
  • Humans
  • Internship and Residency*
  • Iowa