Intended for healthcare professionals

Learning In Practice

What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1017
  1. Arri Coomarasamy, specialist registrar in obstetrics and gynaecology (arricoomar{at},
  2. Khalid S Khan, consultant obstetrician and gynaecologist1
  1. 1 Education Resource Centre, Birmingham Women's Hospital, Birmingham, B15 2TG
  1. Correspondence to: A Coomarasamy


    Objective To evaluate the effects of standalone versus clinically integrated teaching in evidence based medicine on various outcomes in postgraduates.

    Design Systematic review of randomised and non-randomised controlled trials and before and after comparison studies.

    Data sources Medline, Embase, ERIC, Cochrane Library, DARE, HTA database, Best Evidence, BEME, and SCI.

    Study selection 23 studies: four randomised trials, seven non-randomised controlled studies, and 12 before and after comparison studies. 18 studies (including two randomised trials) evaluated a standalone teaching method, and five studies (including two randomised trials) evaluated a clinically integrated teaching method.

    Main outcome measures Knowledge, critical appraisal skills, attitudes, and behaviour.

    Results Standalone teaching improved knowledge but not skills, attitudes, or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes, and behaviour.

    Conclusion Teaching of evidence based medicine should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.


    • Contributors AC and KSK conceived, conducted, and wrote the review. AC is the guarantor.

    • Funding None.

    • Competing interests AC and KSK have a grant from West Midlands Deanery to teach EBM to specialist registrars in the region, as well as a European Union Grant (LSE031068WM2) to promote EBM among small to medium size enterprises that supply the NHS.

    • Ethical approval Not required.

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