Download Implementation of evidence-based practice in education

ASSISTANT PROFESSOR/PHD STUDENT FACULTY OF HEALTH AND SOCIAL SCIENCES, CENTRE FOR EVIDENCE BASED PRACTICE/ DEPARTMENT OF OCCUPATIONAL THERAPY, PHYSIOTHERAPY AND RADIOGRAPHY, BERGEN UNIVERSITY COLLEGE

Implementation of evidence-based practice in education Nina Rydland Olsen

Why heat for my neck pain? http://www.ablebody.ca/wpcontent/uploads/2012/04/Neck-2.jpg

Shared decision making (SDM)1 http://www.wikihow.com/Treat-Neck-and-BackPain-Naturally

1Chewning,

B., Bylund, C. L., Shah, B., Arora, N. K., Gueguen, J. A., & Makoul, G. (2012). Patient preferences for shared decisions: A systematic review. Patient Education and Counseling, 86(1), 9-18. doi: http://dx.doi.org/10.1016/j.pec.2011.02.004 1http://sdm.rightcare.nhs.uk/

1Swennen,

Colleagues is a preferred source of evidence

M. H., van der Heijden, G. J., Boeije, H. R., van Rheenen, N., Verheul, F. J., van der Graaf, Y., & Kalkman, C. J. (2013). Doctors' perceptions and use of evidence-based medicine: a systematic review and thematic synthesis of qualitative studies. Acad Med, 88(9), 1384-1396. doi: 10.1097/ACM.0b013e31829ed3cc 2Ubbink, D. T., Guyatt, G. H., & Vermeulen, H. (2013). Framework of policy recommendations for implementation of evidence-based practice: a systematic scoping review. BMJ Open, 3(1). doi: 10.1136/bmjopen-2012-001881 3Rappolt S, Tassone M: How rehabilitation therapists gather, evaluate, and implement new knowledge. J Contin Educ Health Prof 2002, 22(3):170–180. 4 Estabrooks CA, Scott-Findlay S, Winther C: A Nursing and Allied Health Sciences Perspective on Knowledge Utilization. In Using Knowledge and Evidence in Health Care. Edited by LemieuxCharles L, Champagne F. Toronto: University of Toronto Press; 2004:242–280.

Topics • • • • •

What is EBP EBP curriculum EBP tools Faculty development EBP role models

Patient values and experience Context

Evidencebased Practice Current best evidence

Clinical expertise

Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J. Sicily statement on evidence-based practice. BMC Medical Education 2005; 5: 1. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71-72. Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9: e86706.

Evidence-based Practice (EBP) • • • •

Systematic approach Caring for patients creates a need for research evidence Life long learning A shift from fact memorization to critical reasoning

Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9: e86706.

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https://www.flickr.com/photos/teegardin/5860234733/sizes/l/

Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., . . . Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet, 376(9756), 1923-1958. doi: 10.1016/S0140-6736(10)61854-5 World Health Organization (2004). World Report on Knowledge for Better Health: Strengthening Health Systems. http://www.who.int/rpc/meetings/world_report_on_knowledge_for_better_health.pdf?ua=1

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Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, et al. (2005) Sicily statement on evidence-based practice. BMC Med Educ 5: 1.

Not just a research course… • EBP teaching: previously emphasised critically appraising research. • Sicily statement: curricula based on the “5 step model” › ASK, FIND, APPRAISE, APPLY/INTEGRATE, EVALUATE

Horsley, T., Hyde, C., Santesso, N., Parkes, J., Milne, R., & Stewart, R. (2011). Teaching critical appraisal skills in healthcare settings. Cochrane Database Syst Rev(11), CD001270. doi: 10.1002/14651858.CD001270.pub2 Pourtney, L. G. (2004). Evidence-based practice and clinical decision making: it's not just the research course anymore. Journal of Physical Therapy Education, 18(3), 46-51.

EBP curriculum • Structure within the larger curriculum vary: › Stand-alone courses › Clinical courses › Mixed approaches

Lewis, L. K. (2010). Evidence based practice in physiotherapy entry-level education. (Doctoral thesis), University of South Australia Adelaide. Meats, E., Heneghan, C., Crilly, M., & Glasziou, P. (2009). Evidence-based medicine teaching in UK medical schools. Med Teach, 31(4), 332-337. doi: 10.1080/01421590802572791

Blanco et al. 2014 .

Different ways: Lectures Workshops (e.g. CASP) Journal clubs Patient reports Assignments Group work Exams Bed-side teaching Etc.

EBP in clinical education • Role modelling • Use research evidence when teaching • Teach specific EBP skills

Straus, S. E., & Sackett, D. L. (2005). Evidence-based medicine: how to practice and teach EBM (3rd ed.). Edinburgh: Elsevier Churchill Livingstone.

Evidence-based delivery format? • Face-to-face vs online • Active learning vs traditional lecturing1 • Learning in groups (e.g. problem based learning, team-based)

• The Best Evidence Medical Education (BEME) Collaboration: › The development of evidence informed education in the medical and health professions: http://www.bemecollaboration.org/

1Freeman,

S., Eddy, S. L., McDonough, M., Smith, M. K., Okoroafor, N., Jordt, H., & Wenderoth, M. P. (2014). Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences, 111(23), 8410-8415. doi: 10.1073/pnas.1319030111

Effectiveness of EBP teaching • • • •

Multifaceted teaching strategies Clinically integrated Involve assessment Interactive

Khan, K. S., & Coomarasamy, A. (2006). A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine. BMC Medical Education, 6, 59. Young T, Rohwer A, Volmink J, Clarke M (2014) What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews. PLoS One 9: e86706.

How to describe educational interventions

Phillips, A., Lewis, L., McEvoy, M., Galipeau, J., Glasziou, P., Hammick, M., . . . Williams, M. (2014). A systematic review of how studies describe educational interventions for evidence-based practice: stage 1 of the development of a reporting guideline. BMC Medical Education, 14(1), 152.

EBP learning outcomes • • • • • •

Reaction Self-efficacy Attitudes/ beliefs Knowledge Skills Behaviour

Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, Whelan C, Green M. Instruments for evaluating education in evidence-based practice: a systematic review. JAMA 2006; 296: 1116-27. Tilson JK, Kaplan SL, Harris JL, Hutchinson A, Ilic D, Niederman R, Potomkova J, Zwolsman SE. Sicily statement on classification and development of evidence-based practice learning assessment tools. BMC Medical Education 2011; 11: 78.

EBP across the curriculum • • • • •

When? (timing) What? (content) How? (delivery format) Where? (setting) How much? (amount, hours)

Olsen et al. 2014, Mc Evoy et al. 2010, McEvoy et al. 2011

EBP tools • • • • • •

EBP steps Clinical questions PICO EBP resources (databases, pre-appraised evidence) EBP learning tools (e.g. portfolios, CATs) etc.

EBP steps 5. Evaluate

4. Integrate

1. Ask

2.Search

3. Appraise

Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Martin, J., Hopayian, K., . . . Osborne, J. (2005). Sicily statement on evidence-based practice. BMC Medical Education, 5(1), 1. Sackett, D. L., Rosenberg, W. M., Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: what it is and what it isn't. BMJ, 312(7023), 71-72.

Clinical questions • • • • •

Effects of intervention Patient experiences The course of the condition (prognosis) The accuracy of diagnostic tests (diagnosis) What is the cause of this problem (aetiology)

Guide the literature search

PART I

PART II

Need for expert teachers in EBP • •

Insufficient education on EBP: a potential barrier Teachers need: › ›

EBP skills and knowledge Skills and courage(?) to teach EBP

Lack of role models • Lack role models with strong skills in EBP • CIs need training in EBP • Lack of support

Florin et al. 2012

Why do students struggle to apply EBP?

Olsen, N. R., Bradley, P., Lomborg, K., & Nortvedt, M. W. (2013). Evidence based practice in clinical physiotherapy education: a qualitative interpretive description. BMC Medical Education, 13(1), 52. doi: 10.1186/1472-6920-13-52

National and local agreement Current best evidence on teaching

EBP across curriculum

EBP in education

EBP role models

Expert teachers

Defined learning outcomes

Assessment

Motivated students