Dancing Between the Purist and the Practical: Teaching Evidence- Based Medicine in the 3rd Year Family Medicine Clerkship

Abstract

OBJECTIVE: To teach 3rd year medical students in a Family Medicine rotation the concepts and methods required to practice Evidence-Based Medicine and how to search for that evidence. The course was developed with an emphasis on finding resources and included an extensive epidemiological and statistical component. Using student evaluations, the evolution over five years will be explored. METHODS: The didactic and experimental curriculum was developed with a strict interpretation of search strategies and EBM philosophy and rationale. In 1999, the class contained a detailed component on epidemiology and statistical interpretation of the four clinical study categories (etiology, diagnosis, therapy and prognosis). Following each session, student evaluations were solicited and changes were made to the curriculum based on student feedback and follow-up faculty discussion. Today, a more treatment-centered ethics-based curriculum is taught. While Evidence-Based vocabulary and some statistics such as Absolute Risk and Number Needed to Treat and Harm are included, emphasis is now placed on teaching students to look for good evidence and to use these findings within an effective patient interaction. Collected student evaluations from across the five-year time span will be analyzed to demonstrate the evolutionary steps of the curriculum. RESULTS & CONCLUSIONS: “More time for searching!” This is always a top comment on student evaluations. Ways to make this happen are consistently being identified and put into practice. As class time is limited, what is taught and how it is taught has become very selective. One recently incorporated tool is the use of a pre-session WebCT-based orientation. Material is always being added within this format to free up class time for more interactive practice. Two other practical content areas that have recently been introduced into the course are a) talking with patients about relative risk and b) understanding bias in the medical literature. The very simple evaluation form remains a device with which to collect further student feedback. The course will continue to be updated as EBM methodologies and outlooks within the medical community change and grow.