COMSEP 2008 Atlanta Meeting
An Online Exercise to Explore EBM Skills and Beliefs
Linda Orkin Lewin, Nancy Robert, Carol Carraccio
Objectives: Physicians need excellent Evidence Based Medicine (EBM) skills as well as an ability to assess their skills and recognize their own biases in order to provide quality patient care. The purpose of this program is to raise awareness of how beliefs about knowledge and interpretations of scientific data impact clinical decision making, how individual learner beliefs compare to their colleagues, and to compare perceived versus actual EBM skills.
Methods: Students complete a computer-based EBM exercise during their pediatrics clerkship. Questions address 1) beliefs abouth interpreting meta-analyses, phase 3 trials, and qualitative research; 2) sources of information they use to decide treatment for a hypothetical patient; 3) self-assessment of their EBM skills; and 4) their actual EBM abilities. Students receive feedback as graphic representations that show how their beliefs, knowledge and application of scientific evidence translate into clinical problem solving. Personal profiles are juxtaposed with aggregate peer data. Correlation of their self-assessment of EBM skills with actual skills is also shown. They attend a debriefing session to discuss the exercise, the feedback profiles, and complete an evaluation form.
Results: 65 students completed the exercise between July and February, 2008. It took an average of 25 minutes. Data show that students have more confidence in the results of meta-analyses and phase 3 clinical trials than of qualitative studies. There was notable variation in the data used to solve the clinical case. Self-assessment of EBM skills matched actual skill in some students, but many under- or over-rated their skills. Evaluations by students emphasized the need for a debriefing session to clarify: the intent of the exercise, some of the actual questions, and the clinical application of what was learned.
Discussion: This exercise opened a meaningful discussion about how beliefs and attitudes surrounding knowledge impact patient care. It also opened a conversation about the value of reflection and peer group comparison in self- assessment. Finally, the pitfalls as well as the importance of self-assessment were raised. This methodology holds promise for uncovering medical student beliefs in a variety of important areas.