Incorporating competence-based learning into an evidence-based practice program

Introduction/ Background. The practice of evidence-based medicine requires clinicians to search and appraise the evidence-base to improve patient care. However, many clinicians and medical students are not proficient in conducting effective literature searches. This problem was evident in the neurosurgery weekly case meetings at the Australian School of Advanced Medicine (ASAM), where trainees could not provide adequate literature reviews to support their clinical recommendations. In order to practise evidence-based medicine, contribute to translational research, and become lifelong learners, clinicians must learn how to independently search for, appraise and manage the biomedical literature. Without these skills they will be unable to develop their core roles as “medical expert”, “scholar” and “teacher”, as defined by the CANMeds Physician Competency Framework. Purpose/Objectives This study investigates the development of an evidence-based surgery (EBS) program for neurosurgery trainees at the Australian School of Advanced Medicine (ASAM) that is embedded into educational, research, and clinical contexts and where mastery of learning is measured using outcomes-based assessment. Methods A competence-based EBS program for neurosurgery trainees was developed by ASAM neurosurgeons and the clinical librarian. Literature searching and appraisal skills development were linked to patient cases, and their mastery assessed with a checklist incorporating international information literacy standards. Weekly case presentations provided a forum for clinicians’ literature search strategies, results, evaluation and
recommendations. The clinical librarian provided support to clinicians’ literature searches and assessed their presentations with supervising neurosurgeons. Results Trainees’ achievements of learning outcomes were documented throughout the program. Improvements in skills development were demonstrated in key areas of question formulation, search strategy development, iterative searching and critical appraisal. Many trainees have used their new skills when developing manuscripts for publication, presentations and theses preparation. The clinical librarian’s role as a member of the educational team facilitated trainees’ achievement of learning outcomes. Conclusions These results indicate that contextual learning using measurable outcomes promotes the development of literature searching and appraisal skills as part of the evidence-based practice cycle. Competence-based assessment drives learning in this environment. The principles of this program have been adapted to a unit, Evidence-Based Practice, that is available in all ASAM courses and where the achievement of learning outcomes in finding the best available evidence to support clinical decision making can be measured.