Entries in EBM (13)


Teaching Information Retrieval Skills to Medical Students

This review suggests a longitudinal approach to EBM training, which is what we've done in my environment. Unfortunately, our MRSQ paper on this curriculum wasn't included in their analysis for some reason, but it aligns with many of their findings/suggestions.  




J Med Libr Assoc. 2014 Jul;102(3):184-91. doi: 10.3163/1536-5050.102.3.008.

How are medical students trained to locate biomedical information to practice evidence-based medicine? areview of the 2007-2012 literature.

Maggio LAKung JY.


This study describes how information retrieval skills are taught in evidence-based medicine (EBM) at the undergraduatemedical education (UGME) level.


The authors systematically searched MEDLINE, Scopus, Educational Resource Information Center, Web of Science, andEvidence-Based Medicine Reviews for English-language articles published between 2007 and 2012 describing information retrieval training to support EBM. Data on learning environment, frequency of training, learner characteristics, resources and information skills taught, teaching modalities, and instructor roles were compiled and analyzed.


Twelve studies were identified for analysis. Studies were set in the United States (9), Australia (1), the Czech Republic (1), and Iran (1). Most trainings (7) featured multiple sessions with trainings offered to preclinical students (5) and clinical students (6). A single study described a longitudinal training experience. A variety of information resources were introduced, including PubMed, DynaMed, UpToDate, and AccessMedicine. The majority of the interventions (10) were classified as interactive teaching sessions in classroom settings. Librarians played major and collaborative roles with physicians in teaching and designing training. Unfortunately, few studies provided details ofinformation skills activities or evaluations, making them difficult to evaluate and replicate.


This study reviewed the literature and characterized how EBM search skills are taught in UGME. Details are provided on learning environment, frequency of training, level of learners, resources and skills trained, and instructor roles.


The results suggest a number of steps that librarians can take to improve information skills training including using a longitudinal approach, integrating consumer health resources, and developing robust assessments


Effective EBM Instruction

Good article.  Of the 10 factors, the three that most resonate with me (from my experience at UMich) are:

  • Using a situational cue of role modeling for teaching EBM
A positive learning environment, with attending physicians serving as EBM role models, might be one of the most important factors influencing the behavior of residents. EBM teachers’ role-modeling helps learners see how evidence is incorporated with other knowledge into clinical decisions and how evidence is used as part of good practice. 
  • Increasing learners' awareness of EBM information resources
Learners’ awareness and perceptions of existing EBM information resources can affect the subsequent steps of evidence-based practice that they take, including critically appraising the evidence and applying it to patient care. Green and Huff found that a lack of awareness and limited access to clinical information resources posted barriers for residents in taking the series of steps involved in learning and practicing EBM...
It is important for health sciences librarians to partner with EBM faculty to identify learners' information needs; to acquire point-of-care, pre-appraised EBM information resources; and to incorporate the resources into EBM instructional content and activities to support EBM learning and enhance learners' ability to practice EBM.
  • Developing a longitudinal EBM curriculum to reinforce EBM knowledge and skills
Medical students' learning is developmental and progressive. A longitudinal EBM learning experience provides students with continuous reinforcement and relevance of concepts and statistics that underline EBM. The introduction of EBM in preclinical years should be aligned with the students' developmental stage. As students progress to clinical clerkships, they are provided opportunities to apply EBM principles and critical appraisal skills to evaluate the clinical evidence relevant to the patient problem that they encounter in clinics.  


Mi M. (2013). Factors that influence effective evidence-based medicine instruction. Medical Reference Services Quarterly, 32(4), 424-433. PMID 24180650


How Current Are Point of Care Resources?

I don't think it's reasonable to expect point of care resources to be 100% current all the time, but the number of outdated topic summaries in some is substantial:

Source: PMID 23220465

The authors suggest further research be done to improve updating efficiency, which makes me wonder what a reasonable expectation for currency is.  A new study should be evaluated and considered w/i the context of current recommendations before it's added to one of these resources.  How quickly can this be done?  How much can the process be automated?  

FWIW: Of the 4 in this study, Dynamed seems to balance update speed and quality the best.


TED Talk on Publication Bias

And how such bias impacts evidence-based medicine.  


Spinning RCT Results

According to this PLOS Med article, the source of press spins can be traced to article abstracts:

“Spin” was identified in about half of press releases and media coverage. In multivariable analysis, the main factor associated with “spin” in press releases was the presence of “spin” in the article abstract conclusion. (Source)

Table 1 lists the types of spin the authors identified in their sample of RCT abstracts:

  • No acknowledgement of nonstatistically significant primary outcome
  • Claiming equivalence when results failed to demonstrate a statistically significant difference
  • Focus on positive secondary outcome
  • Focus on inappropriate subgroup
  • Focus on within-group (or over-all within) comparison
  • Nonstatistically significant outcome reported as if they were significant
  • Inadequate claim of safety
  • Inappropriate extrapolation

While the sample is small & the focus is narrow, I can see this being an effective talking point in critical appraisal discussions.

(via Evidence-Based Health)