Questions Remain about Whether EBM Competencies Learned in Medical School are Retained in Residency

Suzanne Lewis

Abstract


Objective – To assess medical graduates’ use of evidence based medicine (EBM) in residency, self-perception of EBM skills, attitudes toward EBM, and the impact of a formal EBM curriculum in their third undergraduate year.


Design – A longitudinal follow-up study by self-administered questionnaire.

Setting – Internal medicine residency programs in US hospitals.

Subjects – A convenience sample of 2001 and 2002 graduates of the University of Illinois College of Medicine at Peoria (UICOM-P) (n=78), and their respective residency program directors (n=72).

Methods – A student graduate questionnaire (SGQ) was sent to all members of UICOM-P’s 2001 and 2002 graduating classes who had completed the EBM course during their M-3 Internal Medicine clerkship. A program director questionnaire (PDQ), similar to the SGQ, was sent to the graduates’ residency program directors. The research instrument was tested with a pilot group prior to use, but not validated. The questionnaires consisted of 4 main sections. The first section examined formal and informal EBM programs in the graduates’ residency curriculum. The second section consisted of a self-assessment of EBM skills by the residents and an assessment of those skills by their program directors. The third section asked graduates to compare their EBM skills to those of their fellow residents who had not been students at UICOM-P. Similarly, in the third section of the PDQ, program directors were asked to compare the EBM skills of UICOM-P graduates and non-UICOM-P graduates participating in the residency program. The last section concerned professional and demographic characteristics. Copies of the surveys were mailed out to non-responders after 6 weeks. Results were collated but statistical analysis was not applied.

Main results – The response rate was 32% for residents and 35% for program directors. The number of incomplete surveys was not reported. Forty-four percent of all respondents reported having a formal EBM curriculum for residents, and 76% reported an informal curriculum. For both formal and informal programs, the most common teaching formats were journal clubs, followed by lectures, teaching rounds, morning reports, bedside consultations, ambulatory clinics and seminars. In section two of the questionnaires, both residents and program directors rated the residents’ EBM skills similarly. However, the residents rated their skills in searching the literature and application of findings to clinical practice higher than the program directors. Program directors also rated the residents’ skills in understanding statistics and tests higher than the residents themselves. Twenty-four percent of both residents and program directors rated the UICOM-P graduates as “very competent” or “extremely competent” in EBM skills (50). Only 35% of program directors and 27% of residents rated the UICOM-P graduates’ EBM skills as “usually better” or “always better” than their peers who were not UICOM-P graduates (50).

Conclusion - The authors of this study conclude that, for UICOM-P graduates, “it might be implied from these results that the EBM skills gained during medical school were retained through their medical school graduation and into their residency training” (51). However, this study has methodological weaknesses which make it difficult to draw any definite conclusions from the results.


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