evidence-based health care (ebhc) tutorials february...

SURMEPI Stellenbosch University Rural Medical Education Partnership Initiative

2012/07/19 SURMEPI Website http://surmepi.sun.ac.za of 29

Evidence-based Health Care (EBHC) tutorials

February – October 2012

INTERIM REPORT

Venue: Worcester Rural Clinical School

A Rohwer, T Young, A Schoonees

Centre for Evidence-based Health Care

Faculty of Health Sciences

Stellenbosch University

www.sun.ac.za/cebhc

Date: 19 July 2012

http://www.sun.ac.za/cebhc



1. Background

Stellenbosch University has obtained funding for the Stellenbosch University Rural Medical

Educational Partnership Initiative (SURMEPI), aiming to enhance the skills of medical professionals in

HIV/AIDS and TB care, as well as increasing the research capacity in this field. Strengthening

evidence-based health care (EBHC) knowledge and skills at an undergraduate level is particularly

important within this context.

In 2011 Taryn Young and Anke Rohwer visited the Rural Clinical School (RCS) in Worcester to learn

more about the students doing their student internship (6th year of the MB,ChB) on the rural

platform. We met with Prof Hoffie Conradie and talked to him about the work we are doing at the

Centre for Evidence-based Health Care (CEBHC) related to the SURMEPI project. We also had lunch

with the students, giving us an opportunity to talk to them about EBHC. In addition we used the

opportunity to show the students a screencast developed by our team on How to search PubMed

using MeSH terms, which they found very useful and asked for similar online resources to build their

capacity in EBHC. We also attended one of their tutorial sessions, which are presented once a week

on Wednesday afternoons. After some discussions with Prof Hoffie Conradie, he managed to secure

six EBHC tutorial sessions for the 2012 student interns on the rural platform, spread throughout the

year.

2. General information about the tutorial sessions

Twenty one student interns from Worcester (17), Swellendam (2) and Robertson (2) participate in

the 2012 tutorial sessions. These are predominantly Afrikaans speaking students (see Appendix 1 for

list of participants). At least two staff members from the CEBHC facilitate each tutorial session.

We developed a structured plan for the six sessions (Appendix 2), covering the following topics:

Introduction to EBHC and formulating questions; Searching databases for relevant studies; How to

read a randomised controlled trial (RCT); How to read a systematic review; How to read a clinical

guideline and revision.



Each two hour tutorial consists of didactic input followed by hands-on class exercises and

discussions. Students were given a folder with relevant reading material and worksheets for

exercises at the first session. Before the first and after the last tutorial, students are being asked to

complete a questionnaire to rate their confidence in EBHC by completing questions based on the

EPIC scale1, and to assess their attitude towards EBHC by using a Likert-scale to answer a second set

of questions2.

During all tutorials, we also make use of interactive teaching techniques to revise content and to

encourage students’ participation in the session. Each student receives a set of flash-cards, a pack

containing five differently coloured cards. Students then answer MCQ-type questions with colour-

coded answers, displayed on the PowerPoint slides, by holding up the coloured card of the

appropriate answer that best fit the question.

After each session, students are asked to complete an evaluation form and relevant reading material

for the following session is handed out.

The reading material includes three excellent books related to EBHC. SURMEPI funding allowed us to

procure copies of the following books which we are distributing in the appropriate sessions:

Questions Log: A tool for ‘just-in-time’ learning by Carl Henegan and Paul Glasziou

Searching Skills Toolkit: Finding the evidence by Caroline De Brun and Nicola Pearce-Smith

How to read a paper: The basics of evidence-based medicine by Trisha Greenhalgh

3. Communication and interaction with students between tutorial sessions

We set up an email list which we are using to communicate with the students. They are encouraged

to contact us with any queries they may have related to content and application of EBHC. In

addition, a set of key resources for EBHC has been developed and made available to students. This

together with the screen cast has been placed on the online learning platform of the RCS.

1 EPIC scale (Salbach 2012) that measures self-perceived EBHC competence on a scale from 0% (no confidence)

to 100% (completely confident) 2 Likert scale ratings of EBHC statements adapted from Baum 2003, from strongly disagree to strongly agree



4. Session 1, 15 February 2012: Introduction to EBHC and formulating questions

Facilitated by Anke Rohwer and Charles Okwundu

Aim:

o The aim of this tutorial was to familiarise students with the basic principles and

application of EBHC and reinforce students’ knowledge and skills in formulating

answerable questions using the PICO approach.

Learning outcomes:

o After the tutorial students should be able to:

Explain what is meant by EBHC

Explain the importance of practicing EBHC

Name the five steps of EBHC

Identify knowledge gaps

Formulate focused answerable questions using the PICO format when faced with an

uncertain situation

Identify the various types of questions

Identify the various types of study designs

Explain what is meant by hierarchy of evidence

Programme

Anke started the tutorial with a welcome and introduction of the CEBHC. Before starting with

any didactic input, we asked students to rate their self-perceived confidence in EBHC by

completing questions based on the EPIC scale. See Appendix 4 for results of the pre-course

questionnaire.

Anke gave the first presentation on Principles and application of Evidence-based Medicine (EBM),

followed by a presentation by Charles on Formulating an answerable question.



Students were then given a variety of scenarios and had to work in groups to phrase appropriate

PICO questions. These included questions on therapy, prognosis, diagnosis, risk factors and

harm. Each scenario and PCIO question was then discussed with the whole class.

In order to make the theory more applicable to students’ own practice, we encouraged them to

send us questions arising from their own clinical experiences via email. We gave them feedback

on their questions, so that they could refine and use them to build their search strategy at the

next tutorial session. We also gave each student a copy of the pocket book Questions Log: A tool

for ‘just-in-time’ learning by Carl Henegan and Paul Glasziou. This can be used as a record of

students’ own questions and answers and is small enough to carry with them while working in

the clinical field.

Evaluation

Overall, we received positive feedback from the students. See Appendix 3 for the full evaluation

report.

o The practical session was very good and helped to understand the work better. Both

session were helpful and well presented

o I learnt what study to use when asking or trying to get answers to various questions. Was

presented in an interesting format

o Interactive learning opportunity and the sparkles



5. Session 2, 6 June 2012: Searching databases for relevant studies

Facilitated by Anke Rohwer and Anel Schoonees

Aim:

o The aim of this tutorial was to familiarise students with searching different databases

Learning outcomes:


Identify appropriate search terms

Use Medical Subject Headings (MeSH) terms in search

Use appropriate limits (e.g. age, gender, publication type)

Use Boolean operators correctly

Combine search concepts in final search strategy

Identify the best sources of evidence for each type of question

Explain why this source would be the best

Design a search strategy relevant to the question

Identify appropriate databases

Search effectively and efficiently for evidence-based resources

Programme

Anel started off the session with a set of flash-card questions to revise the content of the

previous tutorial. Questions covered the basic principles of EBHC, as well as formulating

questions.

Anke then gave a PowerPoint presentation on Finding the evidence. This included a

demonstration on how to search Medline, The Cochrane Library and TRIP database. Students

then watched a screencast on Searching PubMed using MeSH terms.

For the second part of the tutorial, students had the opportunity to take the questions they had

formulated, develop a search strategy and do hands-on searching of the different databases.

Anke and Anel were available to give support and advice on searching techniques.



Evaluation

Overall, we received positive feedback from the students. They liked the interactive nature of

the session and found searching various databases much easier with the tools we gave them.

During the hands-on session, most of the students found suitable articles to answer their

question. See Appendix 3 for the full evaluation report.



6. Session 3, 18 July 2012: How to read a RCT

Facilitated by Anke Rohwer and Mark Engel

Aim:

o The aim of this tutorial was to familiarise students with the basic principles of a

randomised controlled trial (RCT) and the basic principles of critical appraisal of a RCT.

Learning outcomes:


Explain the basic principles of a RCT

Explain the general approach to critical appraisal

Appraise a randomized controlled trial for validity, reliability, and applicability

using the GATE framework

Interpret the research findings for both

Dichotomous outcomes

Continuous outcomes

Explain confidence intervals and p-values

Interpret confidence intervals and p-values

Explain and apply the approach to assessing applicability and generalizability of

research findings in clinical practice

Programme

Anke started the session with a set of flashcard questions, revising the content of the previous

tutorial. Questions covered the basic principles of accessing the literature.

Mark then presented an overview of study designs, the basic principles of a RCT, as well as

measures of effect (risk ratios, odds ratios) and statistical concepts (95% confidence intervals

and p-values).

After a short break, Anke then explained critical appraisal, using the GATE framework and the

RAMMbo acronym, to the students. The presentation included a videoclip on allocation

concealment.



For the practical part of the tutorial, students critically appraised the RCT given to them during

the previous session, in groups of three. This particular RCT was selected based on one of the

student’s PICO questions that she formulated after the first EBHC tutorial. Students were also

given the RCT worksheet by the Oxford Centre for Evidence-based Medicine, which is based on

the GATE framework and the RAMMbo acronym, to use as a guide.

We ended the session with a class discussion on the critical appraisal. Students were each given

a copy of the Searching skills toolkit booklet as well as Trisha Greenhalgh’s How to read a paper.

Evaluation

Overall, we received positive feedback from the students, although some felt that there was

too much information to digest in one session. They enjoyed the interactive nature of the

presentations, as well as the practical session. See Appendix 3 for the full evaluation report.

o I will definitely use this knowledge (soon)!

o Use of different teaching methods.

o Practical – to critically appraise an article and to see how to think about it.



7. Conclusion

The first three EBHC tutorial sessions were very successful. The student interns actively participated

in sessions, asking questions and engaging with the content. Overall, we received very positive

feedback for all the sessions. Evaluation of the sessions showed that students enjoyed the

interactive nature of the sessions and acknowledged their need to revise EBHC concepts.

This is an interim report on the first three EBHC tutorials held at the RCS in Worcester. The last two

EBHC tutorial sessions for 2012 will cover How to read a systematic review and How to read a

guideline. This report will be updated after each session and finalised after the last session.

It is essential that undergraduate medical students have EBHC competencies when they graduate.

Not only does this equip them with the necessary tools to deal with the information overload we are

facing and encourage them to adopt a philosophy of life-long learning; but it enables them to make

more informed decisions about health care. In a country like South Africa, where the burden of

disease is high and resources are scarce, it is essential that beneficial and effective practices are

adopted and harmful, ineffective ones abandoned. This is also highlighted in the recent Lancet

report on the health professional for the 21st century3, which proposes that health care professional

training should become transformative. One of the fundamental shifts of transformative learning

aligns almost perfectly with the steps of EBHC; the shift from memorization of facts to “critical

reasoning that can guide the capacity to search, analyse, assess and synthesise information for

decision-making”.

3 Frenk et al. Health professionals for a new century: transforming education to strengthen health systems

in an interdependent world. The Lancet 2010, 376:1923-58



Appendices

Appendix 1 - Participants

Name Student nr District Sex Home language 15 Feb 6 June 18 July 22 Aug 17 Oct

Jeanne-Marie Louw 14272571 Worcester F Afrikaans Yes Yes Yes

Virgilio Da Conceicao 14816903 Worcester M Yes Yes No

Petronella Magagula 15106500 Worcester F Swati Yes Yes Yes

Elouise Kroon 14102528 Worcester F Afrikaans Yes Yes Yes

Jasper van Zyl 15061833 Worcester M Afrikaans Yes Yes Yes

Sheldon Marais 14821869 Worcester M Afrikaans Yes Yes Yes

Ilze van Wyk 15019233 Worcester F Afrikaans Yes Yes No

Rohan du Plessis 14314258 Worcester M Afrikaans Yes Yes No

Marcia Vermeulen 15040437 Worcester F Afrikaans Yes Yes Yes

Vimbai Tembo 15100324 Worcester F Shona Yes Yes Yes



Willem Naude Worcester M Afrikaans Yes Yes No

Jaco Cilliers 15058788 Worcester M Afrikaans Yes Yes No

Loretha Compion 14775719 Swellendam F Afrikaans Yes Yes Yes

Hane Stander 15019063 Swellendam F Afrikaans Yes Yes Yes

Rethe Maree 14826119 Worcester F Afrikaans Yes Yes No

Kristi Steyn 14798999 Worcester F Afrikaans Yes Yes Yes

Sanele Mjekevu 15127834 Robertson M Zulu Yes Yes Yes

CJ Fouche 14790181 Worcester M Afrikaans Yes Yes No

Niel Bruwer 15061639 Worcester M Afrikaans Yes Yes No

HJ Retief 15082016 Worcester M Afrikaans Yes Yes No

Zinhle Shozi 15101320 Robertson F Zulu Yes Yes No



Appendix 2 – Session outlines

15 February: Introduction to EBHC and formulating questions

Objectives:

To familiarise students with the basic principles and application of EBHC and

reinforce students’ knowledge and skills in formulating answerable questions

using the PICO approach.

Content:

o Basic principles of EBHC

o Application of EBHC

o Principles of phrasing different types of questions

Learning outcomes:

o After the session students should be able to:

i. Explain what is meant by EBHC

ii. Explain the importance of practicing EBHC

iii. Name the five steps of EBHC

iv. Identify knowledge gaps

v. Formulate focused answerable questions using the PICO format when

faced with an uncertain situation

vi. Identify the various types of questions

vii. Identify the various types of study designs

viii. Explain what is meant by hierarchy of evidence

Handouts/resources:

o EBHC resource page

o Worksheet on PICO and phrasing questions

o Worksheet with different scenarios

o Akobeng, AK. Principles of evidence based medicine. Arch Dis Child 2005;

90:837-840

o Akobeng AK. Evidence in practice Arch Dis Child 2005;90:849–852.

o Glasziou P, Haynes B. The paths from research to improved health outcomes.

ACP Journal Club 2005:142(2);8-10

o Questions log book from Oxford

Class exercises

o Scenarios of different types of questions – students to work in groups of 3 to

phrase PICO questions



o Students to use PICO hand-out

Facilitators

o Anke

o Charles

Student preparation for next tutorial:

o Students to email at least one scenario from their own clinical work as well as

the PICO question to the class and tutors for discussion before 30 May 2012

o Bring PICO question to next session

o Look at screencasts on LMS (basic searching and MeSH terms)

6 June: Searching databases for relevant studies

1. Objectives of the session:

To familiarise students with searching different databases

2. Content

Principles of searching electronic databases

Demonstration of searches on PubMed, The Cochrane Library, TRIP database

3. Learning outcomes

After the session, students should be able to: i. Identify appropriate search terms

ii. Use Medical Subject Headings (MeSH) terms in search iii. Use appropriate limits (e.g. age, gender, publication type) iv. Use Boolean operators correctly v. Combine search concepts in final search strategy

vi. Identify the best sources of evidence for each type of question vii. Explain why this source would be the best

viii. Design a search strategy relevant to the question ix. Identify appropriate databases x. Search effectively and efficiently for evidence-based resources

4. Hand-outs/resources

Screencast on Search strategy and MeSH terms

PICO worksheet to identify keywords

Searching skills tool kit (Oxford)

5. Class exercises:

Students to use their PICO question from their clinical work to identify keywords

and develop a search strategy



Hands-on searching

6. Facilitators

Anke

Charles

Anel

7. Student preparation and hand outs for next session:

Read RCT (ref)

Akobeng AK. Understanding randomised controlled trials. Arch Dis Child

2005;90:840-84

18 July: How to read a randomised controlled trial

1. Objectives:

To familiarise students with the basic principles of a randomised controlled trial

(RCT)

To familiarise students with the basic principles of critical appraisal of a RCT

2. Content:

Principles of a RCT

Principles of critical appraisal

Critical appraisal of a RCT

Application of research findings

3. Learning outcomes:

After the tutorial, students should be able to:

i. Explain the basic principles of a RCT ii. Explain the general approach to critical appraisal

iii. Appraise a randomized controlled trial for validity, reliability, and applicability using the GATE framework

iv. Interpret the research findings for both 1. Dichotomous outcomes 2. Continuous outcomes

v. Explain confidence intervals and p-values vi. Interpret confidence intervals and p-values

vii. Explain and apply the approach to assessing applicability and generalizability of research findings in clinical practice

4. Hand-outs/resources:



Akobeng AK. Understanding randomised controlled trials. Arch Dis Child

2005;90:840-844

Hand-out on appraising a RCT

GATE framework

RCT to appraise

5. Class exercises:

Reading an RCT

Working in pairs to critically appraise the RCT

6. Facilitators:

Mark

Anke


Read Systematic review (to be handed out)

Akobeng AK, Understanding systematic reviews and meta-analysis. Arch Dis

Child 2005;90:845-848

PRISMA statement

AMSTAR tool

22 August: How to read a systematic review

1. Objectives:

To familiarise the students with the basic principles of a systematic review

To familiarise students with the basic principles of critically appraising a

systematic review

2. Content:

Basic principles of a systematic review

Critical appraisal of a systematic review

Application of research findings



i. Explain the basic principles of a systematic review ii. Explain the general approach to critical appraisal of a systematic review

iii. Appraise a systematic review for validity, reliability, and applicability using the AMSTAR tool



iv. Interpret a forest plot v. Interpret the research findings for both

1. Dichotomous outcomes 2. Continuous outcomes

vi. Explain confidence intervals and p-values vii. Interpret confidence intervals and p-values

viii. Explain and apply the approach to assessing applicability and generalizability of research findings in clinical practice


Akobeng AK, Understanding systematic reviews and meta-analysis. Arch Dis

Child 2005;90:845-848

AMSTAR tool

PRISMA statement

A systematic review

5. Class exercise:

Reading the systematic review

Working in pairs to critically appraise the systematic review

6. Facilitators

Anke

Mark


Read a Guideline

Reading on guidelines

AGREE II

17 October: How to read a guideline and revision

How to read a guideline:

1. Objectives:

To familiarise the students with the basic principles of a guideline

To familiarise students with the basic principles of critically appraising a

guideline

2. Content:

Basic principles of a guideline

Critical appraisal of a guideline

Application of guidelines





i. Explain the basic principles of a guideline ii. Explain the general approach to critical appraisal of a guideline

iii. Appraise a guideline for validity, reliability, and applicability using the AGREE II tool

iv. Explain and apply the approach to assessing applicability and generalizability of research findings in clinical practice


Woolf SH, Grol R, Hutchinson A, Eccles M, Grimshaw J. Potential benefits,

limitations, and harms of clinical guidelines. BMJ 1999;318:527-30

AGREE II tool

A guideline: Deshpande GC, Rao SC, Keil AD, Patole S. Evidence-based guidelines

for use of probiotics in preterm neonates. BMC Medicine 2011,9:92

5. Class exercise:

Reading the guideline

Working in pairs to critically appraise the guideline

6. Facilitators

Michael

Anke

Mark


Questions and concepts to be revised to be emailed to tutors

Revision

1. Objectives:

To revise the content covered in the previous tutorials

To reinforce difficult concepts

2. Content:

Revision of all steps of EBHC

Quiz to test students’ knowledge (flashcards)

Opportunity for questions

Reinforcement of difficult concepts (asking students in previous session what

they would like to revise)



3. Resources:

Flashcards

4. Class exercise

Quiz

Exercise on difficult concepts e.g. forest plot

5. Facilitators:

Anke

Anel

Charles

6. Evaluation

Evaluation forms to be completed by students.

Post-course questionnaire to be completed by the students



Appendix 3 – Evaluation: Collated feedback

Evidence-based health care (EBHC) tutorial sessions:

Worcester Rural Clinical School 2012

Evaluation Form - Feedback

Introduction to EBHC and formulating questions: 15 February 2012

Please complete the evaluation form and place in the box:

1. What I liked best about the tutorial was:

The sparkles. The cards. The practical application session

Clinical scenario's

Interesting and good presentation

Interactive session both PowerPoint and tutorial examples

Clear explanations with examples

The practical session was very good and helped to understand the work better. Both

session were helpful and well presented

The information was given systematically and explained very well. The flash cards

I learnt what study to use when asking or trying to get answers to various questions.

Was presented in an interesting format

Interactive session. Flash cards. Graphics

Oorsig van EBM

The interaction

Very interactive, practical

Steps of EBM process where well explained. Case studies. Flash cards kept us

involved

Interactive; opportunity to practice skills

Interactive learning opportunity and the sparkles

The coloured cards



Learning about formulating questions and different studies

Practical applications and examples discussed

I enjoyed both the introduction, helping me to orientate myself regarding EBM, as

well as the practical session

2. What I liked least about the tutorial was:

The slides are not available

Nothing

No Afrikaans teaching received

Nothing. Was very good. Thank you

The realisation that there are many things that I don’t know about EBM

Complicated terms

Geen break tussen sessies

Too late in the afternoon

Would be nice to at least receive our notes in both English and Afrikaans

The length of the session

Length of the session

Take long to discuss one topic

Just got tired towards the end

3. Please the box that best describes your thoughts about the presenters and the

presentations

Poor

Unsatisfactory

Satisfactory

Good

Excellent

Did the presentations meet your

expectations?

3 12 4

How would you rate the quality of the

presentations?

1 15 3

Was the content relevant to your

area of work?

2 13 4

Reasons/Comments

The presentation was very informative but the session needs just a 5min break otherwise its

difficult to keep concentrating

Could we please get the slides emailed to us

Very well presented. It was understandable and not too much information at once, Thank you

This lecture was useful and I enjoyed it



4. Please the box that best describes your thoughts about the class

exercises/discussions:

Not at all

useful

Not useful

Satisfactory

Useful

Very useful

Please rate the usefulness of class

exercises/discussions

2 6 9

Reasons/Comments

It helped so much to understand the work better

Practical hands on exercise

5. Other comments:

I would appreciate it if not could also be available on Afrikaans

The tutorial examples helped to solidify the knowledge learnt from PowerPoint

presentations. The slides were precise and relevant in addressing the knowledge

gaps I had

Can the PowerPoint of lectures be made available

Thanks for the file and the programme for the year

Thank you for your efforts

Thank you very much for being organised and approachable

Thank you, we appreciate your feedback.





Evaluation Form

Searching the literature: 6 June 2012



The easy practical approach to the search tools, it was really helpful

and will make any further research I do much easier

Goeie informasie. Praktiese sessie het baie gehelp [Good information.

Practical session helped a lot.]

How to use the databases

Onmiddelikke praktiese toepassing van wat aangebied is [The fact

that we could immediately practice what we’ve learnt]

Goed georganiseer [Well organised]

Clear and understandable

It was very practical and informative, and very helpful for future use

The presenters were good and keen to help. It was and will be of

value to us when we have to gather information. Thank you

The practical powerpoint presentation on how to search for articles

The interactive nature of it


The fact that we had to sit on the floor like pre-school children

Time

I didn’t get enough time to practise to apply the knowledge i.e.

time on the computer

Tutorial was likeable


presentations



Poor

Unsatisfactory

Satisfactory

Good

Excellent

Did the presentations meet your

expectations?

8 2


presentations?

8 2

Was the content relevant to your

area of work?

6 4

Reasons/Comments

Easy, practical, useable

Very good!

Thank you!



Not at all

useful

Not useful

Satisfactory

Useful

Very useful



8 1

Reasons/Comments

It was really good & informative

5. Other comments:

Thank you

Dankie vir die moeite [Thanks for your effort]

Was really good. I would like one more session to practise the searching methods

Thank you very much!






Evaluation Form – Feedback

How to read a RCT: 18 July 2012



Critically appraising the article

Use of different teaching methods. Interactive

I enjoyed both the lecture given as well as the practical session

Taught me how to see if a study is relevant and if I can use it. Now I know how to search for

good evidence based medicine literature. I enjoyed doing practical more than a lecture

The flashcards and sweets

The presentation and then practical application thereof

Interactive. Video and flashcards and sparkles, Makes it easy to concentrate

Practical – to critically appraise and article and to see how to think about it. Sparkles! (thank

you)

Explained clearly. Practical session

Very helpful to understand RCT better

Interactive, interesting tutorial


Not enough time to go through the whole article appraisal

Length of slideshow, I was very tired by the end

I was lost a little bit during the presentation, it felt like too much to take in

Long presentation

Enjoyed everything

May needs some more breaks, 1st tutorial was very long


presentations

Poor

Unsatisfactory

Satisfactory

Good

Excellent

Did the presentations meet your expectations? 9 2




presentations?

4 7

Was the content relevant to your area of work? 8 3

Reasons/Comments

Thank you



Not at all

useful

Not useful

Satisfactory

Useful

Very useful



2 8

Reasons/Comments

Connects the theory with practical work

I will definitely use this knowledge (soon)!

Practical application of difficult theoretical work

5. Other comments:

Thank you for your time and effort

Very good, thank you




Appendix 4 – Pre-course questionnaire

Evidence-based health care (EBHC) tutorial sessions: Worcester Rural Clinical School 2012

Pre-course questionnaire - Feedback

Please rate your confidence in your ability to (tick appropriate box):

0% =no confidence; 100% = completely confident

1. Identify a gap in your knowledge related to a clinical situation (Average = 73%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 0 0 0 1 2 2 7 5 2 2

2. Formulate answerable questions based on your gap in knowledge (Average = 65%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 0 0 1 1 2 9 2 4 1 1

3. Develop a search strategy based on the question (Average = 58%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 0 0 1 3 6 7 0 2 2 0

4. Perform literature searches to address the question (Average = 59%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 1 0 0 1 8 4 4 1 2 0

5. Use MeSH terms in your search (Average = 34%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

4 3 1 2 2 4 3 1 1 0 0

6. Use filters in your search (Average = 45%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

1 2 0 5 2 4 2 4 0 1 0

7. Distinguish between different study designs (Average = 59%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 0 1 3 1 5 1 5 3 2 0

8. Critically appraise the strengths and weaknesses of different study designs



(Average = 47%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 2 1 3 5 2 4 1 3 0 0

9. Select the most relevant study for your question (Average = 55%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 1 0 2 2 6 3 4 3 0 0

10. Determine the validity of a study based on the methodology (Average = 48%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 1 2 3 2 4 5 3 1 0 0

11. Interpret the results of a study with ease (Average = 48%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 2 1 1 6 2 4 4 1 0 0

12. Determine if the evidence obtained applies to your clinical setting(Average = 53%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 1 1 3 1 3 5 5 2 0 0

13. Consider individual patient needs and values (Average = 60%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 1 0 1 1 4 5 4 4 1 0

14. Decide on an appropriate course of action based on integrating the research

evidence, clinical judgement and patient preferences (Average = 56%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 0 1 2 0 8 4 3 2 1 0

15. Evaluate the process of EBM (Average = 44%)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

0 1 2 3 5 5 3 1 1 0 0

Please rate the following by ticking the appropriate box:

16. EBM is realistic to practice in routine patient care

Strongly disagree Disagree Don’t know Agree Strongly agree

0 1 5 13 2

17. EBM is useful on a daily basis.


0 3 5 12 1



18. I think it is important to practice EBM on a regular basis.


0 1 4 14 2

19. I rarely formulate questions about patients seen in my clinic.


0 14 2 5 0

20. Literature searches are too time-consuming to do in a clinic.


0 3 4 10 4

21. My questions can be answered faster when referring to a textbook or a consultant,

than performing the steps of EBM.


0 1 3 13 4

22. All study reports are of equal value to me.


1 11 6 3 0

23. EBM is irrelevant to my practice.


1 15 3 1 1

24. I think EBM is cookbook medicine.


1 9 8 3 0

25. As a health care practitioner, life-long learning is vital.


0 0 0 5 16

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