Chonnam Med J.  2016 May;52(2):107-111. 10.4068/cmj.2016.52.2.107.

Evidence-based Medicine versus the Conventional Approach to Journal Club Sessions: Which One Is More Successful in Teaching Critical Appraisal Skills?

• Alavi-Moghaddam M
• Yazdani S
• Mortazavi
• Chichi S
• Hosseini-Zijoud SM

• KMID: 2164320
• DOI: http://doi.org/10.4068/cmj.2016.52.2.107

Abstract

This study aimed to compare evidence-based medicine (EBM) vs. conventional approaches to journal club sessions in teaching critical appraisal skills in reading papers by emergency medicine residents. This double cut off discontinuation regression quasi-experimental study was conducted among emergency medicine residents. EBM vs. the conventional approach were applied to teach critical appraisal skills for half of the residents as an experimental group and another half as a control group respectively. Both groups participated in one hour monthly journal club sessions for six months. Before and after the study, all participants were examined by two tests: the Fresno Test (FT) [to evaluate their knowledge about EBM] and the Critical Appraisal Skills Test (CAST) [to evaluate their competency with critical appraisal skills]. The allocation of the participants into the experimental or control groups was according to their CAST scores before the study. 50 emergency medicine residents participated. After the study, the scores of both groups in the FT and CAST significantly improved (p<0.01), and the promotion of scores of the FT and CAST in the experimental group were more than that of the conventional group (p<0.0001). The current study indicated that an evidence-based medicine approach in journal club sessions was comparatively more advantageous compared to the conventional approach in teaching critical appraisal skills for reading papers among the residents of emergency medicine.

Keyword

Emergency medicine; Evidence-based medicine; Internship and residency; Knowledge

MeSH Terms

Emergency Medicine
Evidence-Based Medicine*
Internship and Residency
Non-Randomized Controlled Trials as Topic

Figure

• 

  FIG. 1 The scatter plots of Fresno test score. Pre-test and post-test results of both Fresno in both groups (n=25) were compared by analysis of covariance (ANCOVA). Con: Conventional approach (Control Group), EBM: Evidence Based Medicine Approach (Experimental Group).

• 

  FIG. 2 The scatter plots of Critical appraisal skill test score (CAST). Pre-test and post-test results of CAST in both groups (n=25) were compared by analysis of covariance (ANCOVA). Con: Conventional approach (Control Group), EBM: Evidence Based Medicine Approach (Experimental Group).

Reference

1. Ebbert JO, Montori VM, Schultz HJ. The journal club in postgraduate medical education: a systematic review. Med Teach. 2001; 23:455–461.

2. Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med. 1998; 13:347–353.

3. Green ML. Evidence-based medicine training in internal medicine residency programs a national survey. J Gen Intern Med. 2000; 15:129–133.

4. Elstein AS. On the origins and development of evidence-based medicine and medical decision making. Inflamm Res. 2004; 53:Suppl 2. S184–S189.

5. Langkamp DL, Pascoe JM, Nelson DB. The effect of a medical journal club on residents' knowledge of clinical epidemiology and biostatistics. Fam Med. 1992; 24:528–530.

6. Timmermans S, Mauck A. The promises and pitfalls of evidence-based medicine. Health Aff (Millwood). 2005; 24:18–28.

7. Bennett KJ, Sackett DL, Haynes RB, Neufeld VR, Tugwell P, Roberts R. A controlled trial of teaching critical appraisal of the clinical literature to medical students. JAMA. 1987; 257:2451–2454.

8. Kitchens JM, Pfeifer MP. Teaching residents to read the medical literature: a controlled trial of a curriculum in critical appraisal/clinical epidemiology. J Gen Intern Med. 1989; 4:384–387.

9. Linzer M, Brown JT, Frazier LM, DeLong ER, Siegel WC. Impact of a medical journal club on house-staff reading habits, knowledge, and critical appraisal skills. A randomized control trial. JAMA. 1988; 260:2537–2541.

10. Linzer M, DeLong ER, Hupart KH. A comparison of two formats for teaching critical reading skills in a medical journal club. J Med Educ. 1987; 62:690–692.

11. Bazarian JJ, Davis CO, Spillane LL, Blumstein H, Schneider SM. Teaching emergency medicine residents evidence-based critical appraisal skills: a controlled trial. Ann Emerg Med. 1999; 34:148–154.

12. Ibbotson T, Grimshaw J, Grant A. Evaluation of a programme of workshops for promoting the teaching of critical appraisal skills. Med Educ. 1998; 32:486–491.

13. Adib-Hajbaghery M. Factors facilitating and inhibiting evidence-based nursing in Iran. J Adv Nurs. 2007; 58:566–575.

14. Kouhpayehzadeh J, Baradaran H, Arabshahi KS, Knill-Jones R. Clinical teachers' attitudes toward the efficacy of evidence-based medicine workshop and self-reported ability in evidence-based practice in Iran. J Contin Educ Health Prof. 2006; 26:210–214.

15. Mozafarpour S, Sadeghizadeh A, Kabiri P, Taheri H, Attaei M, Khalighinezhad N. Evidence-based medical practice in developing countries: the case study of Iran. J Eval Clin Pract. 2011; 17:651–656.

16. Taheri H, Mirmohamadsadeghi M, Adibi I, Ashorion V, Sadeghizade A, Adibi P. Evidence-based medicine (EBM) for undergraduate medical students. Ann Acad Med Singapore. 2008; 37:764–768.

17. Schwartz MD, Dowell D, Aperi J, Kalet A. Improving journal club presentations, or, I can present that paper in under 10 minutes. ACP J Club. 2007; 147:A8–A9.

18. Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidence-based medicine) skills: a critical appraisal. CMAJ. 1998; 158:177–181.

19. Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer HH, Kunz R. 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; 325:1338–1341.

20. Hatala R, Guyatt G. Evaluating the teaching of evidence-based medicine. JAMA. 2002; 288:1110–1112.

21. Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ. 2003; 326:319–321.

22. Henderson SO, Swadron S, Newton E. Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic. J Emerg Med. 2002; 23:237–241.

23. Parkes J, Hyde C, Deeks J, Milne R. Teaching critical appraisal skills in health care settings. Cochrane Database Syst Rev. 2001; (3):CD001270.

24. Sackett DL. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone;2000.

25. Heneghan C, Badenoch D. Evidence-based medicine toolkit. London: BMJ Books;2002.

26. Dee C, Stanley EE. Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians. J Med Libr Assoc. 2005; 93:213–222.

27. McNeil BJ, Elfrink VL, Bickford CJ, Pierce ST, Beyea SC, Averill C, et al. Nursing information technology knowledge, skills, and preparation of student nurses, nursing faculty, and clinicians: a U.S. survey. J Nurs Educ. 2003; 42:341–349.

28. Profetto-McGrath J. Critical thinking and evidence-based practice. J Prof Nurs. 2005; 21:364–371.

29. Shorten A, Wallace MC, Crookes PA. Developing information literacy: a key to evidence-based nursing. Int Nurs Rev. 2001; 48:86–92.

30. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ. 2004; 329:1017.