Background
Methods
The clinical epidemiology and evidence-based medicine (CE-EBM) module
Topic | Methods | Modulea
|
---|---|---|
Introduction to evidence-based medicine | Lecture | EBM |
How to make an evidence-based case report | Lecture | EBM |
Making an answerable clinical question | Lecture | EBM |
Frequency and association measures | Lecture | CE |
Diagnosis | Lecture | CE |
Prognosis | Lecture | CE |
Formulation of the clinical question; search and comparison of study-book knowledge, study of EBCR design | Group work | EBM |
Intervention | Lecture | CE |
Aetiology | Lecture | CE |
Critical appraisals | Lecture | EBM |
Internet literature search | Practical lecture | EBM |
Computer exercise on prognosis and diagnosis | Practical lecture | CE |
Exercise critical appraisal on therapy | Group work | EBM |
Establishing the search query, literature search and selection, critical appraisal of the selected papers regarding their relevance and methods, description of methods and (provisional) results | Group work | EBM |
Levels of evidence | Lecture | EBM |
Computer exercise on aetiology and intervention | Practical lecture | CE |
Exercise critical appraisal on prognosis and diagnosis | Group work | EBM |
Sorting and structurally summarize the search and appraisal; description of methods and (provisional) results | Group work | EBM |
Exercise critical appraisal on aetiology | Group work | EBM |
Report of EBCR both orally and in writing according to the requirements for form, structure and content; formulation of a recommendation for patient care and further research | Group work | EBM |
Educational activities within the module | Time allocation (h) | |||
---|---|---|---|---|
UI | UM | UMCU | ||
CE | EBM | |||
Lectures | 30 | 22 | 20 | 20 |
Computer practical | 6 | 8 | 10 | 3 |
Tutorial working group | 18 | 14 | 5 | 8 |
Collaborative and individual learninga
| 45 | 0 | 110 | 55 |
Plenary presentation | 4 × 3 | 2 × 3 | 4 × 3 | 4 × 3 |
Total hours | 111 | 50 | 157 | 98 |
Module duration | 4 week | 3 months | 6 weeks | 5 weeks |
Student assessment
Analysis of student assessment data
Ethical considerations
Results
Student assessment
UMCU | UI | UM | |
---|---|---|---|
Pre-test scores | |||
N | 389 | 196 | 160 |
Mean (SD) | 62.20 (9.21) | 54.69 (10.51) | 46.23 (8.69) |
Minimum | 9.38 | 31.58 | 28.12 |
Maximum | 87.50 | 92.11 | 68.75 |
Mean difference (95 % CI) | 7.52 (5.85–9.18) | 15.97 (14.30–17.64) | |
p value | <0.001* | <0.001* | |
Post-test scores | |||
N | 377 | 196 | 200 |
Mean (SD) | 74.75 (9.66) | 73.54 (10.13) | 61.39 (10.39) |
Minimum | 31.25 | 34.21 | 18.75 |
Maximum | 100 | 89.48 | 81.25 |
Mean difference (95 % CI) | 1.32 (0.40–3.04) | 13.36 (11.66–15.06) | |
p value | 0.484† | <0.001† | |
Difference in scores | |||
N | 350 | 196 | 159 |
Post-test minus pre-test | 12.54 (11.44) | 18.85 (12.81) | 17.51 (9.49) |
Mean difference (95 % CI) | 6.32 (4.22–8.41) | 4.98 (2.93–7.02) | |
p value | <0.001* | <0.001* | |
EBCR | |||
N | 71 | 40 | 40 |
Median | 8.0 | 8.4 | 7.8 |
Minimum | 5 | 7.5 | 7 |
Maximum | 10 | 9.0 | 8.6 |
p value | 0.001‡ | 0.44‡ |
Clinical questions | Type of question |
---|---|
University of Indonesia | |
Is artemether–lumefantrine (AL) as effective as artesunate–amodiaquine (ASAD; standard treatment of malaria therapy in Indonesia) for treating uncomplicated childhood malaria? | Therapy |
Mortality after balloon aortic valvuloplasty in male with severe aortic stenosis | Prognosis |
Is the nitrite test accurate as diagnostic tool in pregnant women? | Diagnosis |
In hospitalised elderly patients, is depression related to higher mortality? | Prognosis |
Could calcium supplementation prevent osteoporotic fracture in post-menopausal women? | Therapy |
Diagnostic value of abdominal radiography to diagnose acute appendicitis in children | Diagnosis |
The effectiveness of normal saline solution vs Ringer’s lactate solution to overcome dengue shock syndrome in children | Therapy |
Is acupuncture effective to decrease pain in patient with chronic back pain? | Therapy |
University of Malaya | |
Is exercise stress echocardiography superior in diagnosing patients presenting with chest pain compared with exercise stress electrocardiography? | Diagnosis |
Can Parkinson’s disease be treated more effectively by using dopamine agonists compared with levodopa in Parkinson patients above 50 years? | Therapy |
Do colorectal cancer patients with high levels of tumour markers CEA and CA19-9 have a low 3-year survival rate? | Prognosis |
Does the Revised Trauma Score (RTS) make a good prognostic tool in trauma patients? | Prognosis |
Do children with past history of sexual abuse have increased risk of psychiatric problems in adulthood? | Prognosis |
University Medical Center Utrecht | |
The prognostic value of a history of shoulder pain on predicting the duration of pain in patients presenting with a new episode of shoulder pain | Prognosis |
The influence of physiotherapy on pain in patients with shoulder impingement | Therapy |
Diagnostic ultrasound in a patient suspected of a partial rotator cuff rupture | Diagnosis |
Does treatment with heparin in adults diagnosed with cerebral venous thrombosis reduce mortality within 3-months? | Therapy |
CT venography: the new reference test for diagnosing cerebral venous thrombosis? | Diagnosis |
Glasgow Coma Scale as a prognostic factor in sinus thrombosis | Prognosis |
Prognostic value of current smoking for exacerbations in COPD | Prognosis |
For patients with COPD in the primary care setting: what is the predictive value of CRP for community-acquired pneumonia? | Prognosis |
Diagnostic value of BNP for determining chronic heart failure in patients with COPD | Diagnosis |
Module evaluation
Proportion of students agree (%) | |||
---|---|---|---|
UI | UMCU | UM | |
The objective of the course is achieved | 89 | N.A. | 48.7 |
The course increased my competence (knowledge and skills) | 85 | 95 | N.A. |
The course is useful for my professionalism | N.A. | 60 | 56 |
Discussion
Learning goals
Student assessments
Schools compared
Study limitations
Conclusions
Essentials
-
To introduce clinical epidemiology and evidence-based medicine teaching to medical students, adaptation of an established module from another medical school is more practical than developing a new one.
-
The adaptation process should consider the broad aspect of the local situation including institutional values, resources, structure and organization of the existing medical school curriculum.
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Several contributing factors for successful implementation of the module are initial capacity building for teachers (training of teachers), continuous team discussions and feedback to the teachers, mentoring from the original module developers, and a dedicated module coordinator who is supported by the management of the medical school.