Student-designed survey on the educationof Evidence-Based Medicine
Tomoki Hirata1 Takuya Hanabayashi1 Hiroyuki Oishi1
Kazutaka Kajiura2 Koushiro Tanamoto2 Ohashi Wataru3Yukiko Kuru3 Takahiko Yamamori3 Yoshitaka Fukuzawa3
1. Fourth year student, Aichi Medical University School of Medicine
2. Second year student, Aichi Medical University School of Medicine
3. School of Medicine, Aichi medical university

21st Academic Meeting July 28, 2018

No potential COI to disclose

Outline of the Presentation

1. Background
2. Methods
3. Results & Discussion

Outline of the Presentation

1. Background
2. Methods
3. Results & Discussion

1. Background
Numerous mistakes
in the history of medicine

Phlebotomy, orblood letting,
had long been a
popular medicaltreatment.
Source:Amsterdam Museum1. Background
Numerous mistakes
in the history of medicine
In 1828,
Pierre-Charles
Alexandre Louis provedthat this wasHarmful
by using

Statistical Methods

1. Background
Since the beginning of the 19th century,
Evidence-based medicine (or EBM) has been
regarded as important.

However, it was not until 2 years ago that
the Model Core Curriculum of Medical Educationin Japan included EBM.

1. BackgroundFinding EBM teaching programs in themajority of syllabi on university homepages,
we received an impression that they varied.

Therefore we conducted a multi-university survey
to find out the current status of EBM educationin each school from students’ viewpoints.

Outline of the Presentation

1. Background
2. Methods
3. Results & Discussion

2. Methods

Our survey focused on three areas:
1) curriculum of EBM2) the students’ evaluation on EBM education
3) EBM reading skills

2. Methods
On-line questionnaire by using Google Form

296 responders in
19 universities
March 21-27

This questionnaire wasconducted in Japanese.

2. Methods
Questionnaire

student
researcher“leader” student ofa university

2. Methods“leader” student ofa university

student

student
student

2. Methods
student
researcher

QuestionnaireOutline of the Presentation

1. Background
2. Methods
3. Results & Discussion

3. Result & Discussion

Our survey focused on three areas:
1) curriculum of EBM2) the students’ evaluation on EBM education
3) EBM reading skills

3. Result & Discussion

Our survey focused on three areas:1) curriculum of EBM2) the students’ evaluation on EBM education
3) EBM reading skills

3. Result & Discussion
286 eligible responders belong to following
universities.
Aichi Med Uni
47
Showa Uni
42
Sapporo Uni
35
Fujita Health Uni
25
Kyoto Uni
25
Gifu Uni21
Uni of the Ryukyus 19
Nagoya City Uni
15
Nagoya Uni
13
Kanazawa Med Uni 12

Mie Uni
Dokkyo Med Uni
Toyama Uni
Osaka Uni
Tokushima Uni
Tohoku Uni
Tokyo Uni
National Defense Med College
Hyogo Med Uni

1055441111

Don’tagree toanswer ordon’tbelong tomedicalschool

10

Consent andProfile question

296

286

Have you taken classes onEBM?
Yes 127

Have you been taught how to readclinical research papers in EBM
classes?

No 159No 42

Yes 85

About reading comprehension of the article
Free response（Description）286

Curriculum of EBM

Have you taken classes on EBM?

n=286

Yes

No127

159

Curriculum of EBM
In which subject did you learn EBM?
(multiple answers allowed)
number ofsubjects
answers
English54
Social medicine
27
EBM lectures20
Bedside learning
18
Clinical lectures
10
Statistics or mathematics
6Basic medicine labs etc.
4(Don’t remember)4

number ofuniversities
1186765
3
3n=85 (student) n=19 (university)

3. Result & Discussion

Our survey focused on three areas:
1) curriculum of EBM2) the students’ evaluation on EBM education
3) EBM reading skills

Keller’s ARCS Model of Motivation
Did you find the EBM
classes interesting?

Did you find the EBM
classes useful?

Yes 70.1%

Yes 62.2%

Attention

Relevance

Learner Motivation

Confidence Satisfaction
Do you feel more confident
in reading clinical research
papers after EBM classes?

n=127

Yes 26.8%

Were you satisfied withthe EBM classes?

Yes 61.4%

3. Result & Discussion

Our survey focused on three areas:
1) curriculum of EBM2) the students’ evaluation on EBM education
3) EBM reading skills*

3. Result & Discussion3) EBM reading skills**We define “EBM reading skills” as skills in
extracting information from clinical research
papers written in English, in order toconduct EBM.

EBM reading skills
What factor(s) gives you difficulty in reading
clinical research papers? (multiple answers allowed)

Factors
Medical knowledge
EnglishCritical appraisal
Statistics

number ofanswers

number ofuniversities

118
96
86
74

1616
1714

n=286 (student) n=19 (university)

EBM reading skills
Questions for students’ self-assessmentof EBM reading skills
・Can you find the research question
in a clinical research paper?
・Can you extract PICO (PECO)
from a clinical research paper?
n=286

EBM reading skills
Yes

NoCan you find the researchquestion in a clinicalresearch paper?

32.9% 67.1%

Can you extract PICO(PECO) from a clinicalresearch paper?

18.9% 81.1%n=286

Summary part 1
Students’ perceptions:・56% of the responders took EBM classes.
・Through EBM classes, 60% became motivatedregarding Attention, Relevance, and Satisfaction;less than 30% gained Confidence.
・About one third were able to find theresearch question and a little less than
20% were able to extract PICO.

Further analyses
Students’ perceptions:Through EBM classes, 60% became motivatedregarding Attention, Relevance, and Satisfaction;less than 30% gained Confidence.

To find out the reasons why less students felt
confident in reading clinical research papers,
we conducted further analyses.

Cross tabulation
1. Responses to analyze

・Have you taken classes on EBM?
VS・Can you find research question ina clinical research paper?

We analyzed the data using Fisher's Exact test.

Cross tabulation
Students who
did not take
EBM classes

Students who
took
EBM classes

Students who said
they couldn’t find theresearch question
Students who said
they could find theresearch question

135

57

24

70

286

159

127

Total

p-value<0.001 (Fisher's Exact test)

Cross tabulation

Students who said
they couldn’t find theresearch question
Students who said
they could find theresearch question
Total

286

Students who
did not take
EBM classes

Students whotook
EBM classes

13557

2470159127

p-value<0.001 (Fisher's Exact test)

Cross tabulation

Students who said
they couldn’t find theresearch question
Students who said
they could find theresearch question
Total

286

Students who
did not take
EBM classes

Students who
took
EBM classes

135

57

2470

159

127

p-value<0.001 (Fisher's Exact test)

Cross tabulation
2. Responses to analyze

・In total, how many clinical research papers
did you read for practice in class?
VS・Can you extract PICO (PECO) froma clinical research paper?

We analyzed the data using Fisher's Exact test.

Cross tabulation
Number of papers
students read

0 to 5more than6

Students who said
they couldn’t extract PICO

42

6

Students who said
they could extract PICO

21

16

6322Total

85

p-value=0.0023 (Fisher's Exact test)

Cross tabulation
Number of papers
students read

0 to 5more than6

Students who said
they couldn’t extract PICO

42

6

Students who said
they could extract PICO

21166322

Total

85

p-value=0.0023 (Fisher's Exact test)

Cross tabulation
Number of papers
students read

0 to 5more than6

Students who said
they couldn’t extract PICO

426

Students who said
they could extract PICO

21166322Total

85

p-value=0.0023 (Fisher's Exact test)

Summary part 2
Students’ perceptions:
・EBM classes significantly improved

students’ EBM reading skills.
・Practicing by reading more than 6 papers

significantly improved EBM reading skills.

Limitations
・We collected the data of students’ perceptions
but could not measure their actual EBM readingskills.

・We could not randomly choose universities tosend the questionnaire to.
・The number of responders varying dependingon the university may have affected the results.

Take home messages
・Please teach EBM classes in all medicaluniversities.

・EBM is very difficult for students, so they cannot
easily gain confidence in reading clinical research
papers written in English.
・To give students confidence in extracting informationfrom clinical research papers written in English,
such as PICO, please make them practice reading
more than 6 papers.

References
・Holloway, Robert. Teaching and evaluating first and second year medicalstudents’ practice of evidence-based medicine. Medical Education, 38(8), 868-878,(2004）
・Watanabe, Haruka. A year-round evidence-based medicine-learning course organizedby medical students at Ehime University. Journal of General and Family Medicine,18(4), 175-179, (2017)
・Kitazawa, Kyoko. Questionnaire survey on Evidence-Based Medicine (EBM)
education at the sixth grade medicine department and pharmacy college nationwide.
Japanese Journal of Pharmaceutical Education, 1, 2017-007, (2017)
・Kanda,Y. Investigation of the freely available easy-to-use software ’EZR’ for medicalstatistics. Bone Marrow Transplantation, 48, 452–458, (2013)・Keller, J. M. Development and use of the ARCS model of instructional design. Journalof instructional development,10(3), 2-10, (1987)
・Gaines, J. M. Research on the Effect of Blood-Letting in Several Inflammatory
Maladies Translation of an Article by Pierre-Charles-Alexander Louis (Arch. gen. Méd.
321-336, 1835), with Introduction. Arch Intern Med, 106(4), 571-579, (1960)

Correspondence
Tomoki Hirata: hirata.tomoki.089@mail.aichi-med-u.ac.jp

Contents of questionnaire ①
1. Do you consent to the above-stated conditions?
2. Are you a medical student?
3. Which university do you belong to?
4. What year are you in?
5. Have you taken classes on EBM?
6. What teaching materials were used in your EBM class?
Choose one or more from the list below.
7. What percentage of your EBM class did you attend?
8. Do you think EBM classes are necessary?
9. Did you find the EBM classes useful?
10. Did you find the EBM classes interesting?
11. Do you feel more confident in reading clinical research
papers after taking EBM classes?
12. Were you satisfied with the EBM classes?

Contents of questionnaire ②
13. Were you taught how to read clinical research papers in theEBM class?
14. In which subject(s) did you learn how to read clinical research
papers? Choose one or more from the list below.
e.g. English, EBM, Social Medicine, etc.
15. In total, how many hours did you spend practicing
reading clinical research papers in class?
16. In which year(s) did you learn how to read clinical research
papers?
Choose one or more from the list below.
17. In total, how many clinical research papers did you readfor practice in class?
18. Can you find research question in a clinical research paper?
19. Can you extract PICO (PECO) from a clinical research paper?
20. What factor(s) gives you difficulty in reading clinical research
papers? Choose one or more from the list below. e.g. English,
Statistics, Critical scrutiny, Medical knowledge.