Appendix
MayoMedicalSchool Evidence-Based Medicine Curriculum
Short Course
The short course component of the curriculum consists of 22 contact hours over a roughly 2-week period at the end of the second year of medical school. The goals of this part of the curriculum are to introduce basic concepts of epidemiology and biostatistics pertinent to beginning students of evidence-based medicine (EBM), review the relevance of EBM to clinical practice, and discuss the application of EBM principles in the evaluation of medical literature. Sessions are divided between large-group lecture-style meetings and highly interactive small-group sessions primarily focused on practicing critical appraisal of medical literature. The small groups are facilitated by one instructor and each have approximately 15 students. The large-group sessions are more didactic in nature, although efforts to stimulate interaction are considered essential and the small-group sessions build on concepts introduced in the large groups. The structure of each 1-hour meeting is outlined below. Further details are available upon request to Dr. West at .
Day / Session / Group / Topic1 / 1 / Large / Course structure
Introduction to EBM: History, importance, elements
Pre-test
2 / Large / Background epidemiology topics: study design, bias
Hierarchy of evidence
Homework / Read Therapy article, read Users’ Guides Therapy Chapter
2 / 3 / Small / Therapy article: discuss study design, basic outcomes (relative risk, number need to treat, etc.), review structure of critically appraised topics (CAT’s)
4 / Large / Asking clinical questions
Homework / Read Diagnosis article, read Users’ Guides Diagnosis Chapter
3 / 5 / Small / Diagnosis article: discuss study design, 2x2 tables (sensitivity, specificity, etc.)
6 / Large / Summary of key points from introductory sessions
Introduction to upcoming sessions on core article types
4 / 7 / Large / Searching for answers to clinical questions
8 / Large / Therapy critical appraisal
Homework / Re-read and appraise Therapy article
5 / 9 / Small / Therapy article revisited (full critical appraisal)
10 / Large / Harm critical appraisal
Homework / Read and appraise Harm article
6 / 11 / Small / Harm article
12 / Large / Diagnosis Critical Appraisal
Homework / Re-read and appraise Diagnosis article
7 / 13 / Small / Diagnosis article revisited (full critical appraisal)
14 / Large / Prognosis critical appraisal
Homework / Read and appraise Prognosis article
8 / 15 / Small / Prognosis article
16 / Large / Systematic Review critical appraisal
Homework / Read and appraise Systematic Review article
9 / 17 / Small / Systematic Review article
18 / Large / Tour of additional article types
10 / 19 / Large / Tour of additional EBM issues
20 / Large / Application of EBM to patient care
11 / 21 / Large / Review of EBM Principles
Introduction to longitudinal component of curriculum (CAT’s)
22 / Large / Post-test/Wrap-up
Longitudinal Course
The longitudinal component of the curriculum spans the third year of medical school. The goal of this part of the curriculum is to reinforce the short course learning as students apply their EBM knowledge to actual patient care encounters during their clerkships. During each core third-year clinical rotation (internal medicine, surgery, pediatrics, obstetrics-gynecology, neurology, psychiatry, and family medicine), each student generates a clinical question, searches for an article reflecting the highest level of evidence addressing the question, critically appraises the article, and produces a brief summary of the evidence and how it applies to the patient from whom the clinical question arose. The students turn in their brief critically appraised topic (CAT) summaries and their critical appraisals modeled after the Users’ Guides templates for each article type. The course instructors read each article, evaluate each assignment, and provide substantive written and occasionally verbal feedback to each student for each review. The course is graded on a pass-fail scale. Successful completion of the course is a requirement for medical school graduation, so participation is 100%.
Evaluation
The curriculum was assessed at baseline, after the short course, and at the end of the third year after the longitudinal course. The following self-report questions were used:
1. Self-rating of EBM knowledge (select one):
very poor, poor, fair, good, very good
2. In your opinion, the importance of EBM for medical school education is (select one):
very low, low, fair, high, very high
3. In your opinion, the importance of EBM for clinical practice is (select one):
very low, low, fair, high, very high
In addition, the Berlin Questionnaire has been administered at each study time point. This instrument was originally reported in: Fritsche L et al. Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ. 2002;325:1338-41. The questionnaire is available from the authors upon request.