Learning in practice

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

L Fritsche, senior lecturer, ^a T Greenhalgh, professor, ^b Y Falck-Ytter, researcher, ^c H-H Neumayer, professor, ^a R Kunz, senior lecturer. ^a

^a Department of Nephrology, Charite-Campus Mitte, 10117 Berlin, Germany, ^b Department of Primary Health Care, University College London, London N19 3UA, ^c German Cochrane Centre, Institute for Medical Biometry and Medical Informatics, University of Freiburg, Germany

Correspondence to: R Kunz regina.kunz{at}charite.de

Objective: To develop and validate an instrument for measuring knowledge and skills in evidence based medicine and to investigate whether short courses in evidence based medicine lead to a meaningful increase in knowledge and skills.
Design: Development and validation of an assessment instrument and before and after study.
Setting: Various postgraduate short courses in evidence based medicine in Germany.
Participants: The instrument was validated with experts in evidence based medicine, postgraduate doctors, and medical students. The effect of courses was assessed by postgraduate doctors from medical and surgical backgrounds.
Intervention: Intensive 3 day courses in evidence based medicine delivered through tutor facilitated small groups.
Main outcome measure: Increase in knowledge and skills.
Results: The questionnaire distinguished reliably between groups with different expertise in evidence based medicine. Experts attained a threefold higher average score than students. Postgraduates who had not attended a course performed better than students but significantly worse than experts. Knowledge and skills in evidence based medicine increased after the course by 57% (mean score before course 6.3 (SD 2.9) v 9.9 (SD 2.8), P<0.001). No difference was found among experts or students in absence of an intervention.
Conclusions: The instrument reliably assessed knowledge and skills in evidence based medicine. An intensive 3 day course in evidence based medicine led to a significant increase in knowledge and skills.

What is already known on this topic Numerous observational studies have investigated the impact of teaching evidence based medicine to healthcare professionals, with conflicting results Most of the studies were of poor methodological quality What this study adds An instrument assessing basic knowledge and skills required for practising evidence based medicine was developed and validated An intensive 3 day course on evidence based medicine for doctors from various backgrounds and training level led to a clinically meaningful improvement of knowledge and skills