Education and debate Evaluating the teaching of evidence based medicine: conceptual framework

Interest in evidence based medicine (EBM) has grown exponentially, and professional organisations and training programmes have shifted their agenda from whether to teach EBM to how to teach it. However, there is little evidence about the effectiveness of different methods, and this may be related to the lack of a conceptual framework within which to structure evaluation strategies. In this article we propose a potential framework for evaluating methods of teaching EBM. Showing the effectiveness of such teaching methods relies both on psychometrically strong measurements and methodologically rigorous and appropriate study designs, and our framework addresses the former. This effort was initiated by the Society of General Internal Medicine Evidence-Based Medicine Task Force. In an attempt to tackle the challenges in designing and evaluating a series of teaching workshops on EBM for busy practising clinicians, the task force created a conceptual framework for evaluating teaching methods. This was done by a working group of clinicians interested in the subject. They completed a literature review of instruments used for evaluating teaching of EBM (manuscript in preparation), and two members of the task force used the information to draft a conceptual framework. This framework and relevant background materials were discussed and revised at a consensus conference including 10 physicians interested in EBM, evaluation of education methods, or programme development. We then sent a revised framework to all members of the task force and six other international colleagues interested in the subject.We incorporated their suggestions into the framework presented in this article. When formulating clinical questions, advocates of EBM suggest using the “PICO” approach—defining the patient, intervention, comparison intervention, and outcome. We used this approach to provide a framework for the evaluation matrix, specifically: x Who is the learner? x What is the intervention? x What is the outcome? The answers to these three questions form the structure of our conceptual model. Who is the learner?