Effectiveness of Modalities to Teach Evidence Based Medicine to Pediatric Clerkship Students: a Randomized Controlled Trial

Acad Pediatr. 2020 Sep 30;S1876-2859(20)30510-6. doi: 10.1016/j.acap.2020.09.012. Online ahead of print.


Objective: To evaluate the effectiveness of a traditional didactic session (TDS) as compared to a self-paced, interactive, multimedia module (SPM) on the application of evidence-based medicine (EBM) skills among medical students during their inpatient pediatric rotation.

Methods: We conducted a randomized controlled trial from 6/2017 to 6/2018 at a quaternary care children's hospital. Students were randomized to TDS or SPM during each 2-week block. All students completed a critical appraisal tool (CAT) of evidence related to a clinical question in a standardized appraisal form and self-reflected about the EBM process. The primary outcome was the numeric score of the CAT derived by using the validated Fresno tool. Secondary outcomes of knowledge, attitudes, confidence, and self-reported behaviors related to EBM were measured using validated surveys. Statistical analysis was performed using student's t-test for CAT scores and mixed-model procedure (PROC MIXED), with subject as random effect and time as repeated measure for the secondary outcomes.

Results: 127 clerkship students were included. Overall, there was no significant difference in mean CAT scores for TDS (n=59) versus SPM (n=66) groups (90.3 vs. 92.0, p=0.65). There were no significant differences between SPM and TDS groups for knowledge (p=0.66), attitudes (p=0.97), confidence (p=0.55), and accessing evidence (p=0.27). Both groups showed significant gains in knowledge, attitudes, confidence, and accessing evidence from baseline to post course. Improvements in knowledge and confidence were sustained at 3-months.

Conclusion: A SPM learning module is as effective as a TDS module for application of EBM concepts and knowledge to patient care.

Keywords: Evidence-based medicine; medical student; online learning; undergraduate medical education.