A Longitudinal Analysis of a Curriculum Map for Teaching Evidence-based Medicine to PharmD Students Connie K. Kraus, PharmD, BCPS Beth A. Martin, PhD, RPh University of Wisconsin – School of Pharmacy STFM Annual Meeting – April 24, 2007

Study Aim To determine the effectiveness of a longitudinal course of study in helping students gain knowledge of evidence- based practice principles, skills to appropriately answer clinical questions, and confidence in providing recommendations. IRB Exemption M

Study Objectives To construct a longitudinal curriculum map that exposes students to EBM principles and their application through coursework and writing To measure students’ knowledge of evidence- based practice principles as they progress through the PharmD curriculum To measure students self-reported skills and confidence in performing evidence-based research of clinical questions and providing recommendations

Educational Intervention Timeline DPH-2DPH-3DPH-4 Fall Spring O1 X1 O2 X2 Fall Spring O3 X3 X4 O4 Summer Spring X5 O5 O = Observations; X = Interventions Baseline EBM Knowledge Assessment Two lectures and 1.5hr case-based librarian-facilitated lab with writing assignment Knowledge Assessment & Skills/Confidence Survey (2) Drug Literature Review Course focusing on traditional EBM

Educational Intervention Timeline DPH-2DPH-3DPH-4 Fall Spring O1 X1 O2 X2 Fall Spring O3 X3 X4 O4 Summer Spring X5 O5 O = Observations; X = Interventions Introductory Clerkship with a graded inquiry AND a 1.5hr librarian-facilitated lab with group clinical inquiry Knowledge Assessment & Skills/Confidence Survey (3) Knowledge Assessment & Skills/Confidence Survey (2) Librarian-facilitated colloquium AND Introductory Clerkship with a faculty graded inquiry

Educational Intervention Timeline DPH-2DPH-3DPH-4 Fall Spring O1 X1 O2 X2 Fall Spring O3 X3 X4 O4 Summer Spring X5 O5 O = Observations; X = Interventions Advanced Clerkship Experiences with five graded clinical inquiries Knowledge Assessment & Skills/Confidence Survey (4)

Integration and Collaborative Components Faculty development –Internal –External Health Sciences Librarians Repetition of key concepts Evaluation and assessment tools

Measures EBM Knowledge Assessment –Seventeen multiple choice questions Survey about EBM attitudes, skills, and self-reported confidence –Focus group used to critique items –Adjusted response items based on class year Faculty clinical inquiry grading tool See handout with examples

Knowledge Assessment Results Response rates –DPH2008 (N=127) 81 (64%) baseline KA; 70 (55%) post-training assessments –DPH2009 (N=126) 108 (86%) baseline KA; 56 (44%) post-training assessments Improvements* –Highest % correct: EBM definition, POEM outcome measure, PICO “P”, and least relevant info (only ‘08) –Most: identify a safety and efficacy resource –Lowest/least improved: selecting journal which features POEMS *2009 class had 8% reduction post-training for question which asked them to identify the absolute risk reduction equation

DPH-2 EBM Information Presented (0-100)(0-90)(0-60)(5-95)(1-100) ~ 90% agreed EBM skills necessary as pharmacists

Current Skills (7 items) High Medium Low Current Skill Rating (mode) MED: Search databases & Formulate answer LOW: Formulate answer if no sources & Describe strength of recommendation

Confidence (10 items) Most items rated as Moderately Confident (on five point scale) for both classes –Very Confident (’08): Identifying appropriate search terms –Not Very Confident: Answering the clinical question in a short time frame

Usefulness of Activities (5 items) High Medium Low Usefulness Rating (mode)

Limitations and Challenges IRB exemption –No incentives to encourage student involvement RCT opportunities limited –Although repeated measures design Web administered survey –Convenient for students but limited analyses Survey timing & curricular mandates Multiple players –Requires communication

Study Impact Student publications –Family Physicians Inquiry Network (FPIN) –The Journal of the Pharmacy Society of Wisconsin (JPSW) Student appreciation of pharmacists’ role as an information specialist Faculty awareness and collaboration First curriculum map in the SOP New pharmacy accreditation standards call for teaching of EBM

Future Directions Change in early clerkship experiences anticipated which will allow for more EBM practice opportunities Two-thirds of the data collection Contributions to pharmacy education literature regarding EBM