Learning in practice

Medical students' application of published evidence: randomised trial

Alan Schwartz, assistant professor,  Jordan Hupert, assistant professor. 

Department of Medical Education (M/C 591), 808 South Wood Street, 986 CME, University of Illinois at Chicago, Chicago, IL 60612-7309, USA

Correspondence to: A Schwartz alansz{at}uic.edu

Objectives: To determine how medical students apply research evidence that varies in validity of methods and importance of results to a clinical decision.
Design: Students examined a standardised patient with a whiplash injury, decided whether to order a cervical spine radiograph, and rated their confidence in their decision. They then read one of four randomly assigned variants of a structured abstract from a study of a decision rule that argued against such a procedure in this patient. Variants factorially combined two levels of validity of methods (prospective cohort or chart review) with two levels of importance of results (high sensitivity or high specificity rule). After reading the abstract, students repeated their choice and rated their confidence.
Setting: Academic medical centre in the United States.
Participants: 164 graduating medical students.
Main outcome measures: Proportion of students in each group whose beliefs shifted or stayed the same.
Results: When abstracts were of low importance students were more likely to shift their beliefs in favour of radiography, which was not supported by the evidence (odds ratio 3.42, 95% confidence interval 1.10 to 10.66). Neither methodological validity nor the interaction between validity and importance influenced decision shift. Few students acquired all necessary clinical data from the patient.
Conclusions: Although the students could apply concepts of diagnostic testing, greater focus is needed on appraisal of validity and application of evidence to a particular patient.

What is already known on this topic Evidence based medicine is increasingly emphasised and taught in medical schools Few studies have assessed the ability of physicians to apply literature findings to clinical decisions What this paper adds In making decisions about ordering investigations during a standardised patient exam students were sensitive to the importance of results This effect was not moderated by validity of the study that produced the results or whether the students had collected enough information to apply the results