Application of Adult Learning Theory in Teaching Evidence Based Medicine to Residents

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Background and Purpose: Adequate evidence based medicine (EBM) knowledge and skills are required to provide up-to-date, high quality medical care to patients. Unfortunately, achieving these skills and knowledge requires a prolonged learning process and constant exposure to EBM concepts. The adult learning theory holds the assumption that adults learn better in a problem based and collaborative environment, with more equality in between the teacher and the learner. We aimed to evaluate EBM learning outcomes one year after the implementation of a longitudinal EBM curriculum into an internal medicine residency program.
Methods: An EBM curriculum based on the adult learning theory was developed. It included five specific components that addressed all five steps of the EBM cycle (ask, acquire, appraise, apply and assess). A voluntary, anonymous, 27-question survey was distributed to all residents prior to and at the end of the one year of EBM training to self-assess competencies in EBM.
Results: Of the 60 eligible residents, 10 pre-course and 13 post-course completed the survey with a response rate of 17% and 22%, respectively. Self-reported conceptual understanding improved for: relative risk 14%, odds ratio 14%, confidence intervals 27%, and number needed to treat 12%. Comfort with meta-analysis appraisal improved, from 30% to 38%. Routine appraisal sheet use increased by 31%. A 17% increase in satisfaction with the EBM curriculum was reported.
Conclusions: Our intervention successfully increased residents’ comfort with EBM concepts and self-reported application of EBM skills and knowledge about patient care. The results of the implementation of the EBM curriculum were promising and suggested valuable implications for EBM faculty to further collaborate with residents in continuous improvement of the EBM learning experiences for advancing the quality of patient care