What are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of systematic reviews

Journal Club

6 January 2016

Facilitated by Loai Albarqouni

 

1.  Background

An evidence-based approach to health care is recognized internationally as a key competency for healthcare practitioners.

Various systematic reviews assessing different teaching approaches, and including different target populations, have examined the effects of teaching EBHC.

This paper of interest as we are all engaged in EBHC: attending, facilitating and conducting workshops/courses or designing and testing the impact of new EBM training modules.

 2.  Paper presented

What are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of systematic reviews.  By Young T, Rohwer A, Volmink J, and Clarke M1.

 

Design: Overview of systematic reviews

PICO

P: Undergraduate and postgraduate health professionals (including doctors, dentists, nurses, occupational therapists, physiotherapists, dieticians, audiologists, mental health professionals, psychologists, counsellors, and social workers).

I: any single or multiple educational interventions (defined as a coordinated educational activity, of any medium, duration or format) to teach any component of EBHC.

C: No intervention or different strategies.

O: short-term (Knowledge and skills), medium-term (attitude and behaviour) or long-term (practice and health outcomes).

Study designs: Systematic reviews which included RCT, CT, CBA, BA. Systematic reviews should have predetermined objectives, eligibility criteria, searched at least two data sources (one electronic) and performed data extraction and risk of bias assessment.

Study Appraisal

This article was appraised using the FAITH method:

Find: the authors conducted a comprehensive search (without language restriction) in various databases (7 databases covering medical, health-related and educational databases) and searched for ongoing and unpublished review, reference lists of included studies and contacted expert in the field. It might be better to use MeSH terms and consider searching relevant conferences abstracts as well. The overview eligibility criteria were clear and well defined.

Appraise: Two authors independently extracted the data using a predefined and piloted data extraction sheet. The authors used the AMSTAR (A MeaSurment Tool to Assess Reviews) instrument. The overall quality of included systematic reviews was poor (only 4 assessed high quality).

Include: the authors gave a clear rationale for excluding studies which was not dependent on their quality. Sufficient information about each included review was provided in the supplementary materials.
Total:

The presented article is an interesting well conducted article of high quality. The authors could not pool the effects of teaching EBHC as the included reviews were poorly reported.

Heterogeneity:

The authors found considerable variations in the tools used to assess the outcomes both within and between systematic reviews. The authors planned to pool the effect of teaching EBHC but the findings were poorly reported in most of the included reviews (no effect sizes or significance tests).

3.  Summary of results

Sixteen systematic reviews (15 published + 1 unpublished) + 2 ongoing and 2 awaiting assessment systematic reviews met inclusion criteria. These included 81 deduplicated separate studies (Figure 3).

  • Multifaceted, clinically integrated interventions, with assessment, led to improvements in knowledge, skills and attitudes.
  • Considering single interventions, EBHC knowledge and attitude were similar for lecture-based versus online teaching.
  • Journal clubs appeared to increase clinical epidemiology and biostatistics knowledge and reading behaviour, but not appraisal skills.
  • EBHC courses improved appraisal skills and knowledge where short workshops using problem-based approaches increased knowledge but not appraisal skills.

4.  Discussion/Journal Club commentary 

The presented article is an interesting example of high quality well-conducted overview of systematic reviews. The authors concluded that EBHC teaching strategies should focus on implementing multifaceted, clinically integrated approaches with assessment.

Our journal club discussed the minimum components for EBHC intervention that could be equally effective, and the equivalence between lecture-based and online EBHC training which resonate the findings of a recent RCT of blended learning vs. didactic learning approaches for teaching EBHC2,3.

We have also discussed the inconsistencies in describing the content of EBHC educational interventions in the included separate studies which impede the replication and implementation of their findings. We referred to the currently developing reporting guideline for educational intervention for EBP4.

Our Journal club have also discussed the heterogeneity of outcome measures both between and within included systematic reviews which prevent the authors from providing a pooled effect estimate of the effect of teaching EBHC5. It is worthwhile to have acceptable standardised outcome measures to assess the effect of teaching EBHC.

5.  Reference(s)

  1. Young T, Rohwer A, Volmink J, and Clarke M. What are the Effects of Teaching Evidence-Based Health Care (EBHC)? Overview of systematic reviews. PLoS ONE 2014, 9(1):e86706.
  2. Ilic D, Nordin R, Glasziou P, Tilson J, Villanueva E. A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine. BMC Medical Education 2015;15:39.
  3. Ilic D, Maloney S. Methods of teaching medical trainees Evidence Based Medicine: A systematic review. Med Educ. 2014;48:124–35.
  4. Phillips AC, Lewis LK, McEvoy MP, Galipeau J, Glasziou P, Hammick M, Moher D, Tilson JK, Williams MTA systematic review of how studies describe educational interventions for evidence-based practice: stage 1 of the development of a reporting guideline.BMC Med Educ 2014,14(1):152.
  5. Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C and Green M. Instruments for evaluating education in evidence-based practice: a systematic review. JAMA. 2006; 296: 1116-1127