Why is teaching EBM so damn hard?

July 22, 2015

Preventing Overdiagnosis 2015 Hosted by the National Institutes of Health, National Cancer Institute

Why is teaching EBM so hard?

Why is teaching EBM so damn hard? A question I ask myself, sometimes event in the midst of a class. Give me a lecture on the causes of ‘red eye’ any day – at least the pictures look good. One possible reason is EBM requires understanding of some difficult concepts, as opposed to content knowledge, and if it is not based on actual clinical cases then such understanding is often perceived as superfluous to clinical care, making it even more difficult to teach.

A 2004 systematic review of teaching EBM in postgraduate settings revealed that standalone teaching improves knowledge, but has no effects on skills, attitudes, or behaviour. Whereas clinically integrated teaching improved knowledge, skills, attitudes, and behaviour, the important stuff. However, whilst the quality of the evidence was poor – there were only 2 RCTs to underpin these results – I think we can say that teaching should include moving from the classroom to clinical practice. However, in practice this proves difficult, and what might be better is to think about bringing clinical practice into the classroom.

Khan and Coomarasay, in a 2006 article in BMC medical education, attempted to provide a useful hierarchy of different teaching strategies: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching. What is useful about this hierarchy is not that anyone teaching strategy is really better than any other, well by a substantial amount. But, there are multiple different strategies that can be used throughout a course, and as a teacher of EBM you should be aware of all of these strategies and consider how best to employ them.

As an example,  to move an interactive level 2a classroom based session, to a clinically integrated activity we recently invited a patient to participate in the classroom session, thus making the session interactive and integrated and according to the hierarchy, a level 1 session. Therefore, if you are finding it hard to teach EBM, then you are certainly not alone. One tip would therefore be to try and find a way to integrate clinically activities into the session.

Oh, and good luck.

The 20th Teaching Evidence-Based Medicine will be taking place on September 14th – 17th, 2015, at 
St Hughs College, Oxford

INSpIRE – INcreaSe and ImpRove the teaching of Ebm



Carl Heneghan

About Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

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