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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 4  |  Issue : 3  |  Page : 289-294

Evidence-based medicine workshop for teaching faculty of a medical college: Kirkpatrick level 1 evaluation


1 Department of Community Medicine, Member of the Medical Education Unit, Member of the Medical Research Unit, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Date of Submission28-May-2018
Date of Acceptance11-Jul-2018
Date of Web Publication24-Dec-2018

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, 3rd Floor, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAM.IJAM_20_18

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  Abstract 


Background: Evidence-based medicine (EBM) is a holistic approach of integrating research findings with the existing knowledge in modern medicine. The objective of the present study was to evaluate the reaction level (Kirkpatrick level 1) of the faculty participants who attended a workshop on EBM so that necessary steps can be taken to improve the organization of similar workshops in future.
Materials and Methods: It was a cross-sectional descriptive study, conducted among faculty from different specialties who had attended a 1-day workshop on EBM. A feedback form was used to assess the response of the participants regarding the different aspects of the workshop. Statistical analysis was done using SPSS version 23. Frequency distributions were calculated for all the variables.
Results: The 1-day workshop on EBM was attended by 24 faculty members and it consisted of 5 sessions. All the 24 (100%) participants liked the overall organization of the workshop, with 6 faculty (25%) appreciating the interactive and informative nature of sessions and group activities. Further, 5 (20.8%) faculty members found the workshop to be useful as they were of the opinion that the knowledge gained in the session would aid in the delivery of better patient care, and for better teaching of undergraduate and postgraduate students.
Conclusion: Kirkpatrick level 1 evaluation was done for the EBM workshop, and it was found that all the participants liked the overall organization and content of the workshop, but also expressed their opinion for more exposure on critical appraisal of research articles and searching Cochrane's database.
The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and Improvement.

Keywords: Clinical practice, evaluation, evidence-based medicine


How to cite this article:
Shrivastava SR, Shrivastava PS. Evidence-based medicine workshop for teaching faculty of a medical college: Kirkpatrick level 1 evaluation. Int J Acad Med 2018;4:289-94

How to cite this URL:
Shrivastava SR, Shrivastava PS. Evidence-based medicine workshop for teaching faculty of a medical college: Kirkpatrick level 1 evaluation. Int J Acad Med [serial online] 2018 [cited 2019 May 27];4:289-94. Available from: http://www.ijam-web.org/text.asp?2018/4/3/289/248325




  Introduction Top


The ultimate goals of practicing medicine are straightforward and include a reduction in sufferings, avert future suffering, improve quality of life, and increase life expectancy.[1] However, the groundwork required to accomplish these goals is immense and essentially involves taking a good decision clinically and an insight about various biopsychosocial attributes of every patient.[1],[2]

Evidence-based medicine (EBM) is a holistic approach of integrating research findings with the existing knowledge in modern medicine and is eventually reflected in the delivery of patient care to benefit them.[3],[4],[5] As a matter of fact, EBM in the current era has been regarded as the standard of medical care, as it amalgamates clinical competency with the best available evidences, and provides a framework for clinical decisions by a practitioner.[5],[6]

The findings of available studies clearly indicated that the early introduction of EBM in preclinical years was useful for students and it made them well equipped to appraise new research in medicine for an improved learning experience.[7],[8] In our institute, the practice of EBM has not started formally, and considering the immense need of the same in clinical practice, a 1-day workshop on EBM was organized for the benefit of faculty.[9],[10],[11],[12] The workshop had the objectives that the faculty members should be able to perceive the importance of the EBM and have improvement in the level of knowledge, skill, and practice; and that they should be motivated to incorporate EBM in their daily practice to improve patient care and teaching.

Till date, the majority of the studies which have been conducted for evaluation of an EBM session have focused on Kirkpatrick level 2 evaluation (learning). The objective of the present study was to evaluate the reaction level (Kirkpatrick level 1) of the faculty participants who attended the workshop so that necessary steps can be taken to improve the organization of similar workshops in future.


  Materials and Methods Top


It was a cross-sectional descriptive study, conducted in a tertiary health-care institute. A total of 24 faculty members from 14 different specialties, namely medicine, surgery, pulmonology, psychiatry, dermatology, pediatrics, obstetrics and gynecology, orthopedics, otorhinolaryngology, ophthalmology, anesthesiology, radiology, biochemistry, and community medicine, attended the 1-day workshop on EBM. These participants were from all hierarchy levels and comprised of 12 professors, 6 associate professors, 3 assistant professors, and 3 senior residents.

A feedback form was used to assess the response of the participants regarding the different aspects of the workshop, namely overall experience about workshop, usefulness of the workshop, attributes not liked by participants, topic requiring additional or lesser inputs, feedback about the content of the workshop, and how the workshop could have been organized better [Annexure 1 [Additional file 1]]. Data entry was done into Microsoft Excel sheet, and statistical analysis was done using Statistical Package for Social Sciences version 23 (IBM, United States of America). Frequency distributions were calculated for all the variables.


  Results Top


The 1-day workshop on EBM was attended by 24 faculty, and it consisted of 5 sessions, namely brainstorming session on EBM, principles and practice of EBM, framing the pertinent, focused, relevant and answerable questions (including group activity), finding the best evidence through literature search (demonstration and group activity), and the final session was on advantages, challenges and barriers in EBM, its practice in various specialties and relevance to the developing world. The participants were divided in five groups of five members each with different combinations to enable better sharing of knowledge and information.

Group activity consisted of giving different case scenarios to each group and the members from each group were asked to convert the available medical information into searchable and focused question. This was followed by searching the best evidence through literature search and eventually critical appraisal of the evidence for validity and clinical usefulness. Each of these groups presented their discussion findings in a plenary session and inputs from remaining groups were taken to enhance their understanding. The session on literature search focused on the use of PubMed as the search engine, and participants were explained about “Boolean operators,” Medical Subject Headings words, and a live demonstration was also given. In order to make the entire session interactive, methods such as brainstorming, buzz, and case-based learning were employed in the 1-day workshop.

In addition, a pre- and post-test was kept to assess the learning among the participants. Furthermore, an open house session was kept to encourage faculty to clear their doubts and how they can implement EBM in their respective departments.

[Table 1] depicts the overall experience of the participants of the workshop. All the 24 (100%) participants liked the overall organization of the workshop, with six faculty (25%) appreciated the interactive and informative nature of sessions and group activities. In addition, five (21%) faculty liked the session on literature search on PubMed. However, three (12.5%) faculty members were not satisfied with the time management of the session, and were of the opinion that there were less practical sessions.
Table 1: Workshop attributes liked by participants (n=24)

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[Table 2] represents the relevance of the workshop in department work. Five (20.8%) faculty found the workshop to be useful as they were of the opinion that the knowledge gained in the session will aid in the delivery of better patient care, and for better teaching of undergraduate and postgraduate students. The faculty members expressed that more time/in-depth knowledge should be covered in the topics such as how to participate in EBM, steps involved in EBM, critical appraisal of research articles, and how to use Cochrane Library for the review of literature. Further, it was suggested that in the session on framing a pertinent, focused, relevant and answerable questions, cases from different clinical specialties could have been incorporated.
Table 2: Usefulness of the workshop (n=24)

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[Table 3] shows the feedback about the overall workshop content from all the participants on a Likert scale. In general, six attributes of the workshops were assessed, namely course content was well-organized to make the most effective use of time allotted, training addressed all the objectives discussed at the beginning of workshop, content was appropriate to my training needs and skill level, pre-workshop reading material was easy to read and understand, participants were encouraged to ask questions and engage in discussion, and that resource persons helped the group members in relating the concepts taught with their practice. On an average 15 (62.5%) participants strongly agreed with the mentioned attributes, while 9 (37.5%) faculty members just agreed with the statements.
Table 3: Feedback about the overall workshop content

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All 24 participants opined that they will be recommending these kinds of workshops to their other colleagues, mainly because it gave a comprehensive knowledge about EBM, assisted them in performing literature search and understanding the importance of the same, as EBM is the need of the hour for optimization of patient care, and because it is a must for all medical teachers in modern medicine. In response to the question, how the workshop could have been better, 4 (16.7%) faculty suggested for better time management, while 3 (12.5%) faculty were of the opinion to incorporate a number of group activities. Finally, all participants expressed their desire to be a part of similar workshops in future as well.


  Discussion Top


In the last couple of decades, EBM has been regarded as the gold standard for decision-making and standard for medical practice.[13],[14] Even from the public health perspective, the implementation of an evidence-based health programs is expected to result in a better outcome for both patients and clinicians, and it would also account in reducing the rates of admissions and decline in the involved direct medical costs.[13],[14],[15]

Despite the conduction of EBM sessions as a part of the faculty development program regularly, it has been observed that most of the studies done with an objective to evaluate Kirkpatrick level 3 and 4 outcomes (viz., change in behavior and change in clinical outcomes) after an EBM workshop have not shown encouraging results.[10],[13] This is an indirect indicator that somewhere we are not right, especially in the organization of the workshop, as a result of which the long-term outcome has not been fruitful. In other words, it is quite essential to evaluate the reaction of participants towards the EBM workshop, so that we can rectify our mistakes, which are preventing change in behavior and change in clinical outcomes in the long run.

In the current study, no needs assessment was formally done for the EBM sessions, but preworkshop related reading materials were circulated to the participants. In another study, needs assessment was done before the 1-day EBM workshop, and based on the issues identified, the agenda for the workshop was decided.[10] The findings of the present study indicated that all 24 (100%) participants liked the workshop and found the workshop to be useful for their daily practice of patient care, undergraduate, and postgraduate teaching. The findings of another half-day workshop revealed that a significant change in the attitude, confidence, and other areas of critical skills abilities was reported.[16]

Furthermore, the participants from the current workshop expressed their concurrence that they will be able to practice EBM in the current setup, provided all departmental faculty members are sensitized. In continuation to that faculty member expressed that more time/in-depth knowledge should be covered on topics like how to participate in the EBM and critical appraisal of research articles. On the other hand, the findings of another study indicated that the study participants were quite skeptical about the success of EBM in their setup due to their inability to critically appraise the identified evidence.[13],[16]

In our study, 5 (20.8%) facultys were of the opinion that clinical case scenario from all specialties should have been incorporated in the group activity session of the workshop. On a similar note, the need to formulate a good question while conducting EBM session was emphasized in various other studies.[17],[18],[19],[20] The strength of the present study is that the EBM workshop involved faculty members from the majority of the departments (including preclinical), and that the sessions were taken by experts and that a proper balance between theory and practical sessions was maintained.

Limitations

The study had some limitations, as the findings of the study are based on a single session, that too involving a small number of faculty members. Thus, the findings of the present study cannot be generalized to the entire faculty or all medical colleges.


  Conclusion Top


EBM is a holistic way to effectively integrate acquired medical knowledge for better clinical practice. Kirkpatrick level 1 evaluation was done in the EBM workshop, and it was found that all the participants liked the workshop, but also opined that additional information in areas like how to participate in EBM, critical appraisal of research article, and searching Cochrane Database for review of literature could have been added.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Ethical conduct of research

The study was approved by the Institutional Ethics Committee.



 
  References Top

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[PUBMED]  [Full text]  
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  [Table 1], [Table 2], [Table 3]



 

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