Online Appendix

MayoMedicalSchool Evidence Based Medicine Curriculum

Short Course

The short course component of the curriculum consists of 20 contact hours over a roughly 2-week period at the end of the second year of medical school. The goals of this part of the curriculum are to introduce basic concepts of epidemiology and biostatistics pertinent to beginning students of evidence based medicine (EBM), review the relevance of EBM to clinical practice, and discuss the application of EBM principles in the evaluation of medical literature. Sessions are divided between large-group lecture-style meetings and highly interactive small-group sessions primarily focused on practicing critical appraisal of medical literature. The small groups are facilitated by one instructor and each have approximately 15 students. The large-group sessions are more didactic in nature, although efforts to stimulate interaction are considered essential and the small-group sessions build on concepts introduced in the large groups. The structure of each 1-hour meeting is outlined below. Further details and session materials are available upon request to Dr. West at .

Day / Session / Group / Topic
1 / 1 / Large / Course structure
Introduction to EBM: History, importance, elements
Background epidemiology topics: study design, bias
Hierarchy of evidence
2 / Large / Asking clinical questions
Homework / Read Therapy and Diagnosis articles (focus on abstract, major results)
2 / 3 / Small / Therapy article: discuss study design, basic outcomes (relative risk, number need to treat, etc.), review structure of critically appraised topics (CAT’s)
4 / Small / Diagnosis article: discuss study design, 2x2 tables (sensitivity, specificity, etc.)
Homework / None
3 / 5 / Large / Searching for answers to clinical questions
6 / Large / Therapy critical appraisal
Homework / Re-read and appraise full Therapy article
4 / 7 / Small / Therapy article revisited (full critical appraisal)
8 / Large / Harm critical appraisal
Homework / Read and appraise Harm article
5 / 9 / Small / Harm article appraisal
10 / Large / Diagnosis critical appraisal
Homework / Re-read and appraise full Diagnosis article
6 / 11 / Small / Diagnosis article revisited (full critical appraisal)
12 / Large / Prognosis critical appraisal
Homework / Read and appraise Prognosis article
7 / 13 / Small / Prognosis article appraisal
14 / Large / Systematic Review critical appraisal
Homework / Read and appraise Systematic Review article
8 / 15 / Small / Systematic Review article appraisal
16 / Large / Tour of additional article types
9 / 17 / Large / Tour of additional EBM issues
18 / Large / Application of EBM to patient care
10 / 19 / Large / Review of EBM principles
20 / Large / Introduction to longitudinal component of curriculum (CAT’s)
Wrap-up

Longitudinal Course

The longitudinal component of the curriculum spans the third year of medical school. The goal of this part of the curriculum is to reinforce the short course learning as students apply their EBM knowledge to actual patient care encounters during their clerkships. During each core third-year clinical rotation (internal medicine, surgery, pediatrics, obstetrics-gynecology, neurology, and psychiatry), each student generates a clinical question from a patient encounter, searches for an article reflecting the highest level of evidence addressing the question, critically appraises the article, and produces a brief summary of the evidence and how it applies to the patient from whom the clinical question arose. The students turn in their brief critically appraised topic (CAT) summaries and their critical appraisals modeled after the Users’ Guides templates for each article type. The course instructors read each article, evaluate each assignment, and provide substantive written and occasionally verbal feedback to each student for each review. The course is graded on a pass-fail scale. Successful completion of the course is a requirement for medical school graduation, so participation is 100%.

Assessment

The curriculum has been assessed at its beginning, after the short course, and at the end of the third year after the longitudinal course. The following three self-report questions were asked:

1. Self-rating of EBM knowledge (select one):

very poor, poor, fair, good, very good

2. In your opinion, the importance of EBM for medical school education is (select one):

very low, low, fair, high, very high

3. In your opinion, the importance of EBM for clinical practice is (select one):

very low, low, fair, high, very high

In addition, the Berlin Questionnaire and Fresno Test have been administered at each study time point. The Berlin Questionnaire was originally reported in: Fritsche L et al. 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;325:1338-41. The questionnaire is available from the authors upon request. The Fresno Test was originally reported in: Ramos KD et al. Validation of the Fresno Test of competence in evidence based medicine. BMJ. 2003;326:319-21. The questionnaire is available at bmj.com.