What do we really want our graduates to be? What skills do we want them to acquire to become excellent practitioners? One answer to this question is that our graduates need to become ‘evidence-based’ practitioners and use the latest evidence in professional decision-making.
Written by: Dr Andrew S Davidson (Neurosurgeon) & Mary R Simons (Clinical Librarian)
Being an evidence-based practitioner in any field means integrating one’s expertise and client’s preferences with the best available external research evidence.
For example, it is widely accepted that to effectively practice evidence-based medicine, clinicians must search for and manage the literature within reasonable time frames. Finding, evaluating and using information quickly is a critical skill… But how can we facilitate this when clinicians are already besieged by increasing workloads, lack of time and the information explosion?
We started the evidence-based practice (EBP) program in 2008 to improve the literature searching and appraisal skills of junior doctors presenting weekly case reports. This was in response to our observation that many doctors were unable to find the best evidence to answer patient care questions.
We formed a collaboration of clinicians from Macquarie University Neurosurgery and Spine Unit, and clinical librarians from Macquarie University Library to create an EBP program that encourages students to find the best available evidence for answering patient care questions.
We opted for a ‘modular’ approach as it allows embedding specific topics in different units of study, and it makes it easier for the students to review specific topics.
Eight years and several iterations later we now have modules for each stage of the cycle of evidence: (i) asking the question, (ii) acquiring the evidence, (iii) appraising, (iv) applying the evidence and (iv) assessing the EBP process. Figure 1 shows the cycle of evidence and the corresponding program modules.
On students’ requests we also included modules on research metrics and academic writing.
The EBP modules are now being delivered across a range of undergraduate and postgraduate programs within the Faculty. All EBP learning activities are linked to programmatic learning outcomes and assessment in order to ensure program continuity and relevance of learning.
How we did it: our 5 top considerations
There are 5 features that have enabled our EBP to be pedagogically-sound and helped us to successfully integrate it into new and existing programs of study.
- Contextual – The program is embedded into clinical contexts where the importance of EBP skills acquisition for improving patient care is paramount. The program benefits a lot from being close to the University hospital and clinics that provide ideal EBP learning opportunities through grand rounds, case presentations, journal clubs, ward rounds and simulation activities.
- Spiral curriculum within a modular framework – EBP learning is iterative in its development and delivery as activities are consolidated and increase in complexity at each successive stage of the unit or program. This spiral curriculum creates meaningful learning experiences that build upon previous learning. Our modular approach provides a flexible means of curriculum development that links to programmatic learning outcomes whilst adapting to the specific learning needs of students. For example, the EBP components of the Bachelor of Clinical Science program are introduced into clinical scenarios at an early stage of the program, then reinforced and extended over its two year duration.
- Blended delivery – Trying to make the most of learning technologies, the EBP modules were designed as a blended program using face-to-face tutorials alongside online custom-made video clips, tutorial modules, interactive games, self-correcting quizzes, forums and readings. The Library has a pivotal role in developing these resources with the help of Learning and Teaching staff. Blended learning enables students to be actively involved in managing their learning by completing tasks at their own pace using a variety of learning modes.
- Independent lifelong learning – A philosophy of lifelong learning is a fundamental principle of the EBP program. Students learn how to efficiently search for and evaluate evidence for themselves rather than rely on evidence summaries (also called “Point of care tools” in medicine). Whilst these electronic aids have value in some circumstances, they are often limited by shortcomings in their currency, coverage and accuracy when making recommendations for patient care. In contrast, as EBP and related research skills are acquired through our program, practitioners become independent learners and can contribute to research and to the scholarly literature in their field.
- Collaboration: This program could not be developed, delivered and monitored without the close collaboration between clinical librarians, Macquarie Neurosurgery and Spine clinicians and the Faculty of Medicine and Health Sciences. Learning and Teaching staff, education experts and IT staff provide additional support at various stages of the program’s development and modification.
The most important aspect of running an EBP program, in our opinion, is the ability to work as an interdisciplinary team (i.e., librarians, clinicians, Faculty, IT staff and education experts). This has resulted in a program that we could not have developed by ourselves.
We have also learnt a valuable lesson in remaining flexible as Faculty programs are modified and new programs are created. One thing that helps us to adapt to such changes is being clear about what is achievable through programmatic learning outcomes and assessment.
Another valuable lesson is to approach the program as a ‘modular’ means of on-going learning. These factors help us to adapt to changing learning needs yet remain relevant to each student’s professional discipline.
Informal and formal evaluation of the EBP program indicate it is achieving its aims and supporting the Faculty’s vision of being a world class university health sciences centre that integrates clinical care, learning and research to improve lives.
Student feedback endorses the value of blended learning formats for busy clinicians, and using program-based learning and assessment outcomes that are relevant to their clinical practice. Students frequently comment that using EBP skills saves them time in the long run. Others have published case reports and systematic reviews in scholarly journals as a direct result of their participation in our EBP program. Several clinicians have returned to their home countries/institutions to promote learning, patient care and research using EBP principles. Areas for improvement recommended by students include the need for more time spent on critical appraisal, particularly biomedical statistics.
An exciting feature of the program is that it can be integrated into other disciplines, such as allied health, highlighting its pivotal role across the entire healthcare spectrum. An innovative inter-professional evidence-based healthcare unit of study for the anticipated Global MD program (a postgraduate medical degree) is being planned that will embed EBP into a multidisciplinary, patient-centred environment. In fact the practice of EBP can be incorporated into non-healthcare disciplines, such as education, management, policing and government. We hope our story will inspire other disciplines to consider an evidence-based approach to learning and teaching.
If you would like further information about our program please contact:
Mary Simons: email@example.com or
Andrew Davidson: Andrew.firstname.lastname@example.org