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Evidence Based Medicine: A Review of Basic Concepts, Learning Theories, Teaching Approaches and Assessment Methods

Yıl 2021, , 122 - 136, 30.04.2021

Özlem Serpil Çakmakkaya

https://doi.org/10.25282/ted.720785
Cited By: 6

Öz

Background: Evidence-based medicine is the conscientious explicit and judicious use of current best evidence in combination with clinical experience in making decisions about the care of individual patients. Training on asking clinical questions, effective database searches and critical appraisal of scientific research is necessary to practice evidence-based medicine. The lack of knowledge and skills is one of the important factors that hinder the practice of evidence-based medicine. For this reason, national and international educational organizations and boards emphasize that evidence-based medicine training should be included in the medical school curriculum. However, no consensus has yet been reached on the most effective training methods and assessment-evaluation methods, and a gold standard has not been established. The general approach of medical faculties is to develop the most effective education program in line with their educational programs, goals and objectives and the needs of their students by considering the current education strategies.
Methods: This review is a narrative review. Systematic reviews and meta-analyzes, which are accepted as the highest level of evidence in evidence-based practice, have been systematically searched in the MEDLINE, Cochrane Library and Google Scholar databases using predefined search strategies for the preparation of the review. In addition, original research articles examining evidence-based medicine training in medical education and current conceptual frameworks are examined.
Results: The review provides a comprehensive literature review on the general applications of Evidence-Based Medicine training in the world, the education methods used, the evaluation of education programs and the assessment and measurement methods.
Conclusions: Although there is no strong evidence to provide standardization of evidence-based medicine training in under- and postgraduate medical education, common suggestions from existing studies are to start at the early stages of medical education, covering all steps of evidence-based medicine, being clinically integrated and interactive and using measurement and evaluation tools with strong psychometric properties specific to this area.

Anahtar Kelimeler

Evidence-Based Medicine Medical Education Learning Theories

Kaynakça

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Kanıta Dayalı Tıp: Temel Kavramlar, Öğrenme Teorileri, Eğitim Yaklaşımları ve Ölçme-Değerlendirme Yöntemleri ile İlgili Derleme

Yıl 2021, , 122 - 136, 30.04.2021

Özlem Serpil Çakmakkaya

https://doi.org/10.25282/ted.720785
Cited By: 6

Öz

Amaç: Kanıta dayalı tıp; hekimlerin, hastalarla ilgili tıbbi kararlar verirken klinik deneyimlerinin yanı sıra bilimsel kanıtı da dürüst, açık ve mantıklı şekilde kullanmalarıdır. Kanıta dayalı tıbbı uygulayabilmek için klinik soru oluşturma, veri tabanlarında etkin arama yapma ve bilimsel araştırmaların eleştirel olarak değerlendirilmesi gibi konularda bilgi ve beceriye sahip olmak gereklidir. Kanıta dayalı tıp uygulamalarını engelleyen önemli faktörlerden birisi yeterince bilgi ve beceriye sahip olunmamasıdır. Bu nedenle ulusal ve uluslararası eğitim organizasyonları tıp fakültesi eğitim programlarında kanıta dayalı tıp eğitimlerine yer verilmesi gerektiğini vurgulamaktadır. Ancak gerek en etkin eğitim yöntemi gerekse ölçme-değerlendirme yöntemleri konusunda henüz fikir birliğine varılamamış ve altın standart belirlenmemiştir. Genel yaklaşım tıp fakültelerinin güncel eğitim stratejilerini göz önünde bulundurarak eğitim programları, amaç ve hedefleri ve öğrencilerinin gereksinimleri doğrultusunda kendileri için en etkin olabilecek eğitim programını geliştirmeleri yönündedir. Geleneksel derleme olarak hazırlanan bu makalede kanıta dayalı tıp eğitim programları geliştirilirken göz önünde bulundurulması gereken temel prensiplerin incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Derleme türü geleneksel derlemedir. Derlemenin hazırlanması için önceden belirlenen arama stratejileri kullanılarak MEDLINE, Cochrane ve Google Scholar veri tabanında sistematik tarama yapılmış, kanıta dayalı tıp uygulamalarında en üst kanıt düzeyi olarak kabul edilen sistematik derleme ve meta-analizlere ulaşılarak makalede sonuçlarına yer verilmiştir. Ek olarak tıp eğitiminde kanıta dayalı tıp eğitimlerini inceleyen orijinal araştırma makaleleri ve konu ilgili mevcut kavramsal çerçeveler incelenmiştir.
Bulgular: Derleme Kanıta Dayalı Tıp eğitimlerinin dünyadaki genel uygulamaları, kullanılan eğitim yöntemleri, eğitim programlarının değerlendirilmesi ve ölçme-değerlendirme yöntemlerine ilişkin geniş bir literatür incelemesi sunmaktadır.
Sonuç: Tıp eğitiminde mezuniyet öncesi ve sonrası dönemde uygulanan kanıta dayalı tıp eğitimlerinin standardizasyonu sağlayacak şekilde güçlü kanıtlar mevcut olmamakla birlikte, mevcut çalışmalardan elde edilen ortak öneriler: Kanıta dayalı tıp eğtimlerinin tıp eğitiminin erken dönemlerinde başlaması, kanıta dayalı tıbbın tüm basamaklarını kapsaması, klinikle entegre, interaktif olması ve bu alana özel güçlü psikometrik özelliklere sahip ölçme-değerlendirme araçlarının kullanılması yönündedir. 

Anahtar Kelimeler

Kanıta Dayalı Tıp Tıp Eğitimi Öğrenme Teorileri

Kaynakça

  • 1. Pickering GW. The purpose of medical education. BMJ. 1956;2: 113.
  • 2. Sackett DL. Evidence-Based Medicine. Seminars in Perinatology. 1997;21(1):3-5.
  • 3. Sackett DL, Rosenberg WM, Gray JM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-2.
  • 4. Glasziou P, Burls A, Gilbert R. Evidence based medicine and the medical curriculum. BMJ (Clinical research ed.). 2008;337(7672):704-705.
  • 5. Green ML, Ruff TR. Why do residents fail to answer their clinical questions? A qualitative study of barriers to practicing evidence-based medicine. Academic Medicine. 2005;80(2):176-182.
  • 6. Van Dijk N, Hooft L, Wieringa-de Waard M. What are the barriers to residents' practicing evidence-based medicine? A systematic review. Academic Medicine. 2010;85(7):1163-1170.
  • 7. General Medical Council (2018). Outcomes for graduates. 21 Eylül 2020 tarihinde https://www.gmc-uk.org/-/media/documents/outcomes-for-graduates-a4-6_pdf-78952372.pdf adresinden erişildi.
  • 8. The Accreditation Council for Graduate Medical Education (2020). Common program requirements. 21 Eylül 2020 tarihinde http://www.acgme.org/What-We-Do/Accreditation/Common-Program-Requirements adresinden erişildi.
  • 9. Kozu T. Medical education in Japan. Academic Medicine. 2006;81(12):1069-1075.
  • 10. Ministry of Education, Culture, Sports, Science and Technology (2016). Model Core Curriculum for Medical Education in Japan. 21 Eylül 2020 tarihinde https://www.mext.go.jp/component/a_menu/education/detail/__icsFiles/afieldfile/2018/06/18/1325989_30.pdf adresinden erişildi.
  • 11. Tıp Dekanlar Konseyi (2020). Mezuniyet Öncesi Tıp Eğitimi Ulusal Çekirdek Eğitim Programı. 14 Eylül 2020 tarihinde https://www.yok.gov.tr/kurumsal/idari-birimler/egitim-ogretim-dairesi/ulusal-cekirdek-egitimi-programlari adresinden erişildi.
  • 12. Tıp Eğitimi Programlarını Değerlendirme ve Akreditasyon Derneği (2020). Mezuniyet Öncesi Tıp Eğitimi Ulusal Standartları. 21 Eylül 2020 tarihinde http://tepdad.org.tr/belgeler adresinden erişildi.
  • 13. Thomas RE, Kreptul D. Systematic review of evidence-based medicine tests for family physician residents. Family Medicine. 2015;47(2):101-117.
  • 14. Ahmadi F, Baradaran HR, Ahmadi E. Effectiveness of teaching evidence-based medicine to undergraduate medical students: a BEME systematic review. Medical Teacher. 2015;37(1):21-30.
  • 15. Ilic D, Maloney S. Methods of teaching medical trainees evidence‐based medicine: a systematic review. Medical Education. 2014;48(2):124-135.
  • 16. Young T, Rohwer A, Volmink J, M. Clarke. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PloS One. 2014;9(1).
  • 17. Ahmadi N, McKenzie ME, MacLean A, Brown CJ, Mastracci T, McLeod RS; Evidence-Based Reviews in Surgery Steering Group. Teaching evidence based medicine to surgery residents-is journal club the best format? A systematic review of the literature. Journal of Surgical Education. 2012;69(1):91-100.
  • 18. Flores-Mateo G, Argimon JM. Evidence based practice in postgraduate healthcare education: a systematic review. BMC Health Services Research. 2007;7(1):119.
  • 19. Coomarasamy A, Taylor R, Khan K. A systematic review of postgraduate teaching in evidence-based medicine and critical appraisal. Medical Teacher. 2003;25(1):77-81.
  • 20. Greenhalgh T, Toon P, Russell J, Wong G, Plumb L, Macfarlane F. Transferability of principles of evidence based medicine to improve educational quality: systematic review and case study of an online course in primary health care. BMJ. 2003;326(7381):142-145.
  • 21. Ilic D, Voogt A, Oldroyd J. The use of journal clubs to teach evidence‐based medicine to health professionals: A systematic review and meta‐analysis. Journal of Evidence‐Based Medicine. 2020;13(1):42-56.
  • 22. Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C, Green M. Instruments for evaluating education in evidence-based practice: a systematic review. JAMA. 2006;296(9):1116-1127.
  • 23. Akobeng AK. Principles of evidence based medicine. Archives of Disease in Childhood. 2005;90(8):837-840.
  • 24. Del Fiol G, Workman TE, Gorman P.N. Clinical questions raised by clinicians at the point of care: a systematic review. JAMA Internal Medicine. 2014;174(5):710-718.
  • 25. Brassil E, Gunn B, Shenoy AM, Blanchard R. Unanswered clinical questions: a survey of specialists and primary care providers. Journal of the Medical Library Association: JMLA. 2017;105(1):4.
  • 26. Çakmakkaya, ÖS. Tıp Fakültesi Öğrencilerine Verilen “Kanıta Dayalı Tıp” Eğitiminin Fresno Testi ile Değerlendirilmesi [Doktora Tezi]. Ege Üniversitesi; 2018.
  • 27. Straus SE, Richardson W, Glasziou P, Haynes R, and editors, Evidence Based Medicine: How to Practice and Teach EBM. 4th ed. Edinburgh: Elsevier Churchill Livingstone; 2011.
  • 28. Moja L, Kwag KH, Lytras T, Bertizzolo L, Brandt L, Pecoraro V, Rigon G, Vaona A, Ruggiero F, Mangia M. Effectiveness of computerized decision support systems linked to electronic health records: a systematic review and meta-analysis. American Journal of Public Health. 2014;104(12):e12-22.
  • 29. Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digital Medicine. 2020;3(1):1-10.
  • 30. Groenhof TKJ, Asselbergs FW, Groenwold RH, Grobbee DE, Visseren FL, Bots ML. The effect of computerized decision support systems on cardiovascular risk factors: a systematic review and meta-analysis. BMC medical informatics and decision making, 2019;19(1):108.
  • 31. Akobeng AK. Assessing the validity of clinical trials. Journal of Pediatric Gastroenterology and Nutrition. 2008;47(3):277-282.
  • 32. Mhaskar R, Emmanuel P, Mishra S, Patel S, Naik E, Kumar A. Critical appraisal skills are essential to informed decision-making. Indian Journal of Sexually Transmitted Diseases and AIDS. 2009;30(2):112.
  • 33. Altman DG. The scandal of poor medical research. BMJ. 1994;308:283
  • 34. The Centre for Evidence-Based Medicine (2011). Critical Appraisal Tools. 1 Eylül 2020 tarihinde https://www.cebm.ox.ac.uk/resources/levels-of-evidence/explanation-of-the-2011-ocebm-levels-of-evidence adresinden erişildi.
  • 35. Çakmakkaya ÖS. Bilimsel Kanıta Ulaşmak: Biyomedikal Veri Tabanları ile ilgili Derleme. Yükseköğretim Dergisi. 2012;2(2):104-108.
  • 36. Rao G, Kanter SL. Physician numeracy as the basis for an evidence-based medicine curriculum. Academic Medicine, 2010;85(11):1794-1799.
  • 37. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine, 2010;8(1):.
  • 38. Moher D, Altman DG, Liberati A, Tetzlaff J. PRISMA Statement. Epidemiology. 2011;22(1):128.
  • 39. Das K, Malick S, Khan KS, Tips for teaching evidence-based medicine in a clinical setting: lessons from adult learning theory. Part one. Journal of the Royal Society of Medicine, 2008;101(10):493-500.
  • 40. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ. 2004;329(7473):1017.
  • 41. Amstutz DD. Adult Learning: Moving toward More Inclusive Theories and Practices. New Directions for Adult and Continuing Education. 1999;82:19-32.
  • 42. O’Brien BC, Battista A. Situated learning theory in health professions education research: a scoping review. Advances in Health Sciences Education. 2020;25(2):483-509.
  • 43. Wilson AL. The promise of situated cognition. New Directions For Adult And Continuing Education. 1993;1993(57):71-79.
  • 44. Wenger E. Communities of practice and social learning systems: the career of a concept, in Social Learning Systems and Communities of Practice. 2010;179-198, Springer.
  • 45. Quinn EM, Cantillon P, Redmond HP, Bennett D. Surgical journal club as a community of practice: a case study. Journal of Surgical Education. 2014;71(4):606-612.
  • 46. Hatala R, Guyatt G. Evaluating the teaching of evidence-based medicine. JAMA. 2002;288(9):1110-1112.
  • 47. Maggio LA, Tannery NH, Chen HC, Cate O, O’Brien B. Evidence-based medicine training in undergraduate medical education: a review and critique of the literature published 2006–2011. Academic Medicine. 2013;88(7):1022-1028.
  • 48. Khan KS, Coomarasamy A. A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine. BMC Medical Education. 2006;6(1):59.
  • 49. Harris J, Kearley K, Heneghan C, Meats E, Roberts N, Perera R, Kearley-Shiers K. Are journal clubs effective in supporting evidence-based decision making? A systematic review. BEME Guide No. 16. Medical Teacher. 2011;33(1):9-23.
  • 50. Maggio LA, Cate O, Irby DM, O’Brien BC. Designing evidence-based medicine training to optimize the transfer of skills from the classroom to clinical practice: applying the four component instructional design model. Academic Medicine. 2015;90(11):1457-1461.
  • 51. Ok O, Vatansever K, Araz EŞ, Agah MH, Durak Hİ. Hastane Öncesi̇ Sağlık Profesyonelleri̇ne Yöneli̇k Travma İleri̇ Yaşam Desteği̇ Eği̇ti̇m Programı. Tıp Eğitimi Dünyası. 2018;17(51):60-71.
  • 52. Maggio LA, Capdarest-Arest N. Practising evidence-based medicine (EBM): a descriptive analysis of medical students’ whole-task EBM assignments. Evidence Based Medicine. 2017;22(29):41-4.
  • 53. Nieman LZ, Cheng L, Foxhall LE. Teaching first-year medical students to apply evidence-based practices to patient care. Family Medicine. 2009;41(5):332-336.
  • 54. West CP, Jaeger TM, McDonald FS. Extended evaluation of a longitudinal medical school evidence-based medicine curriculum. Journal of General Internal Medicine. 2011;26(6):611-615.
  • 55. Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ. 2003;326(7384):319-321.
  • 56. Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer H, 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(7376):1338-1341.
  • 57. Ilic D, Nordin RB, Glasziou P, Tilson JK, Villanueva E. Development and validation of the ACE tool: assessing medical trainees’ competency in evidence based medicine. BMC Medical Education. 2014;14(1):114.
  • 58. Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine. 1990;65(9):63-7.
  • 59. Tilson JK, Kaplan SL, Harris JL, Hutchinson A, Ilic D, Niederman R, Potomkova J, Zwolsman SE. Sicily statement on classification and development of evidence-based practice learning assessment tools. BMC Medical Education. 2011;11(1):78.
  • 60. Buljan I, Jerončić A, Malički M, Marušić M, Marušić A. How to choose an evidence-based medicine knowledge test for medical students? Comparison of three knowledge measures. BMC Medical Education. 2018;18(1):290.
  • 61. Argimon-Pallàs JM, Flores-Mateo G, Jiménez-Villa J, Pujol-Ribera E. Psychometric properties of a test in evidence based practice: the Spanish version of the Fresno test. BMC Medical Education. 2010;10(1):45.
  • 62. Cuschieri A, Gleeson F, Harden R, Wood R. A new approach to a final examination in surgery. Use of the objective structured clinical examination. Annals of the Royal College of Surgeons of England. 1979;61(5):400.
  • 63. Bradley P, Humphris G. Assessing the ability of medical students to apply evidence in practice: the potential of the OSCE. Medical Education.1999;33(11):815-817.
  • 64. Frohna JG, Gruppen LD, Fliegel JE, Mangrulkar RS. Development of an evaluation of medical student competence in evidence-based medicine using a computer-based OSCE station. Teaching and Learning in Medicine. 2006;18(3):267-272.
  • 65. Amini R, Hernandez NC, Keim SM, Gordon PR. Using standardized patients to evaluate medical students’ evidence‐based medicine skills. Journal of Evidence‐Based Medicine. 2016;9(1):38-42.
  • 66. Sackett DL. David L Sackett: Interview in 2014 and 2015, in Haynes R, Editor. BMJ. 2015;suppl:2016.
  • 67. Ismach RB. Teaching evidence‐based medicine to medical students. Academic Emergency Medicine. 2004;11(12):e6-10.
  • 68. The Centre for Evidence-Based Medicine (2020). Educational presciption. 21 Eylül 2020 tarihinde https://www.cebm.net/wp-content/uploads/2014/04/educational-prescription_1.pdf adresinden erişildi.
  • 69. Van Tartwijk J, Driessen EW. Portfolios for assessment and learning: AMEE Guide no. 45. Medical Teacher. 2009;31(9):790-801.
  • 70. Fung MFK, Walker M, Fung KFK, Temple L, Lajoie F, Bellemare G, Bryson SP. An Internet‐based learning portfolio in resident education: the KOALA™ multicentre programme. Medical Education. 2000;34(6):474-479.
  • 71. Naik VA, Kotur P, Goudar SS. Evidence based medicine and its impact on medical education. Indian Journal of Anaesthesia. 2002;46(2):96-103.
  • 72. Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J. Sicily statement on evidence-based practice. BMC Medical Education. 2005;5(1):1.
  • 73. Maggio LA. Educating physicians in evidence based medicine: current practices and curricular strategies. Perspectives on Medical Education. 2016;5(6):358-361.
  • 74. Hurd PD. Scientific literacy: New minds for a changing world. Science Education. 1998;82(3):407-416.
Toplam 74 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derleme
Yazarlar

Özlem Serpil Çakmakkaya 0000-0002-3945-1875

Yayımlanma Tarihi 30 Nisan 2021
Gönderilme Tarihi 15 Nisan 2020
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

Vancouver Çakmakkaya ÖS. Kanıta Dayalı Tıp: Temel Kavramlar, Öğrenme Teorileri, Eğitim Yaklaşımları ve Ölçme-Değerlendirme Yöntemleri ile İlgili Derleme. TED. 2021;20(60):122-36.

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