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Instruments for Evaluating Education in Evidence-Based Practice A Systematic Review

Terrence Shaneyfelt, MD, MPH; Karyn D. Baum, MD, MSEd; Douglas Bell, MD, PhD; David Feldstein, MD; Thomas K. Houston, MD, MPH; Scott Kaatz, DO; Chad Whelan, MD; Michael Green, MD, MSc
JAMA. 2006;296(9):1116-1127. doi:10.1001/jama.296.9.1116.
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Context Evidence-based practice (EBP) is the integration of the best research evidence with patients' values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness.

Objective To appraise, summarize, and describe currently available EBP teaching evaluation instruments.

Data Sources and Study Selection We searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument.

Data Extraction Two raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes.

Data Synthesis Of 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures.

Conclusions Instruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

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Figure. Search for and Selection of Articles for Review
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EBP indicates evidence-based practice.
*Articles could be found in more than 1 database (see “Methods” section of text for details of search strategies, databases, and names of the 8 journals whose tables of contents were searched).
†Reasons for exclusion not mutually exclusive.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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