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EBP Research News

EBP教育のレビュー論文のまとめ（更新）

2024.08.04 22:00

EBP教育のレビュー論文を掲載します．


■ 2024

Objectives: Evidence-based dentistry (EBD) training has been widely promoted in dental schools around the world and policymakers ask for suitable strategies to teach EBD within undergraduate dental education. The present study aims to evaluate the effectiveness of these strategies on dental students' knowledge, attitude, and skills.
Methods: PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, and Eric databases were searched using search terms obtained from Medical Subject Headings (MeSH) terms and free text method without time restrictions, up to November 2022. The identified articles were screened based on titles and abstracts for inclusion criteria. Subsequently, relevant articles underwent data extraction. Finally, the risk of bias was assessed through Joanna Briggs Institute critical appraisal checklists.
Results: Twelve of 439 studies were included: nine quasi-experimental studies, two cross-sectional, and one randomized controlled trial study. Regarding the overlap among categories, six studies assessed knowledge, seven assessed attitude, and eight focused on skills or performance in EBD. Due to the heterogeneity of the interventions and results of included studies, a meta-analysis was not performed. EBD was mostly taught in small group collaborations. Interventions included lectures, workshops, seminars, small group sessions, journal clubs, online sessions, or a combination of them in various frequencies and duration.

Conclusions: EBD implementation into dental curricula is improving through strategies including designing continuing and frequent dental education courses, establishing collaborative student research groups, utilizing online tools for EBD education, and dividing EBD courses into shorter modules. The systematic review protocol was registered in PROSPERO (ID: CRD42022350238).


■ 2021

Background: The use of e-learning in nursing education has increased substantially. The goal of this study is to identify how active e-learning for evidence-based practice (EBP) was implemented in academic settings.
Method: For a scoping review, literature from PubMed, CINAHL, and EMBASE was searched with keywords related to e-learning and EBP, and only articles pertaining to nursing academic settings were selected. Finally, 17 studies were included. Data on theories or instructional strategies and types and characteristics of online activities were extracted.
Results: Of the included studies, 14 had a pedagogical background. Frequently used activities included discussions, asynchronous communications, and a combination of student-student and student-teacher interactions. Critical appraisal was the primary learning content.

Conclusion: This study summarizes evidence on active learning to enhance the EBP competency of nursing students through e-learning. To make EBP e-learning more meaningful, educators should plan, apply, and evaluate appropriate online activities.


Background: Evidence-based healthcare (EBHC) knowledge and skills are recognised as core competencies of healthcare professionals worldwide, and teaching EBHC has been widely recommended as an integral part of their training. The objective of this overview of systematic reviews (SR) was to update evidence and assess the effects of various approaches for teaching evidence-based health care (EBHC) at undergraduate (UG) and postgraduate (PG) medical education (ME) level on changes in knowledge, skills, attitudes and behaviour.
Methods and findings: This is an update of an overview that was published in 2014. The process followed standard procedures specified for the previous version of the overview, with a modified search. Searches were conducted in Epistemonikos for SRs published from 1 January 2013 to 27 October 2020 with no language restrictions. We checked additional sources for ongoing and unpublished SRs. Eligibility criteria included: SRs which evaluated educational interventions for teaching EBHC compared to no intervention or a different strategy were eligible. Two reviewers independently selected SRs, extracted data and evaluated quality using standardised instrument (AMSTAR2). The effects of strategies to teach EBHC were synthesized using a narrative approach. Previously published version of this overview included 16 SR, while the updated search identified six additional SRs. We therefore included a total of 22 SRs (with a total of 141 primary studies) in this updated overview. The SRs evaluated different educational interventions of varying duration, frequency, and format to teach various components of EBHC at different levels of ME (UG, PG, mixed). Most SRs assessed a range of EBHC related outcomes using a variety of assessment tools. Two SRs included randomised controlled trials (RCTs) only, while 20 reviews included RCTs and various types of non-RCTs. Diversity of study designs and teaching activities as well as aggregated findings at the SR level prevented comparisons of the effects of different techniques. In general, knowledge was improved across all ME levels for interventions compared to no intervention or pre-test scores. Skills improved in UGs, but less so in PGs and were less consistent in mixed populations. There were positive changes in behaviour among UGs and PGs, but not in mixed populations, with no consistent improvement in attitudes in any of the studied groups. One SR showed improved patient outcomes (based on non-randomised studies). Main limitations included: poor quality and reporting of SRs, heterogeneity of interventions and outcome measures, and short-term follow up.
Conclusions: Teaching EBHC consistently improved EBHC knowledge and skills at all levels of ME and behaviour in UGs and PGs, but with no consistent improvement in attitudes towards EBHC, and little evidence of the long term influence on processes of care and patient outcomes. EBHC teaching and learning should be interactive, multifaceted, integrated into clinical practice, and should include assessments.




■ 2019

Background: Structured journal clubs are a widely used tool to promote evidence-based practice in health professionals, however some journal clubs (JC) are more effectively sustained than others. To date, little research has provided insights into factors which may influence sustainability of JCs within health care settings. As part of a larger randomised controlled study, this research aimed to gain understanding of clinicians' experiences of sustaining a structured JC format (TREAT- Tailoring Research Evidence and Theory) within their clinical context. The study also aimed to identify which strategies may assist longer term sustainability and future implementation of the TREAT format.
Methods: We employed a qualitative methodology, informed by behaviour change theory. Clinicians (n = 19) from five different JCs participated in focus groups to explore their experience in sustaining the JC format six months after the formal trial period had completed. Clinicians were asked to describe factors which they perceived helped or hindered sustaining components of the JC format within their local context. Following a descriptive summary of the data, barriers and enablers were thematically analysed according to behaviour change theory domains: capability, motivation and opportunity and further mapped to targeted implementation strategies.
Results: Participants reported perceived benefits of maintaining the TREAT format and described several components that promoted its sustainability. Sustaining factors linked to individuals' capability included building research knowledge and skills and having access to research experts. Sustaining factors that enhanced opportunities for behaviour change included management expectation to attend and a team culture which values evidence based practice, while factors found to enhance individuals' motivation included the JC having close application to practice and clinicians sensing ownership of the JC. Several implementation strategies to enhance these factors are described including graduated support to clinicians in facilitation of JCs and greater engagement with managers.

Conclusions: Long-term sustainability of a structured JC is dependent on both individual and service level factors and a balance of implementation strategies that enhance capability, opportunity and motivation. Consideration of how clinicians can be engaged to take ownership and build their own capability from the commencement of the JC is important.


■ 2018

Background: Numerous articles have sought to identify the impact of educational interventions for improving evidence-based practice (EBP) amongst nurses, most of these focus on skills and knowledge acquired. No systematic review has explored whether this educational input translates into improved patient outcomes.
Objectives: To review the evidence on (1) The change in patient outcomes following educational interventions to support practising nurses in implementing EBP. (2) The instruments or methods used to determine whether EBP education improves patient outcomes.
Methods: A systematic review following PRISMA guidance was conducted. Literature was comprehensive searched including 6 databases, journal handsearching, citation tracking, and grey literature websites. Studies were included if they reported an EBP educational intervention aimed at practising nurses and contained objective or self-reported measures of patient related outcomes. The quality of the included studies was assessed using a modified Health Care Practice R&D Unit (HCPRDU) tool. Because of the poor homogeneity of the included studies, the data were analysed by narrative synthesis.

Results: Of the 4284 articles identified, 18 were included: 12 pre-post studies, three qualitative studies, and three mixed-methods study designs. The level of quality was modest in the studies. The results of the EBP educational interventions on patient outcomes were assessed using three methods: individual projects to implement an evidence-based approach, qualitative approaches, and a questionnaire survey. The majority of the articles concluded there was a positive change in patient outcomes following an educational intervention to improve EBP; a wide range of context specific outcomes were described.

Conclusion: Educational interventions for clinical nurses to support the implementation of EBP show promise in improving patient outcomes. However, the direct impact of EBP interventions on clinical outcomes is difficult to measure. Further testing and development is needed to improve the quality of studies and evaluation instruments in order to confirm the current findings.


■ 2017

This Campbell systematic review examines the effectiveness of e-learning in improving evidence-based health care (EBHC) knowledge and practice.
Compared to no learning, pure e-learning improves EBHC knowledge and skills but not attitudes and behaviour. Pure e-learning is no better than face-to-face learning in improving any of the primary outcomes.
Blended learning is better than no learning for improving EBHC knowledge, skills, attitude and behaviour; and is better than face-to-face learning in improving attitudes and behaviour.

Compared to pure e-learning, blended learning improves EBHC knowledge. It is not clear which elearning components are most effective in improving outcomes.

However, the included studies were of moderate to low quality, with a small number of studies included in each analysis, and imprecision and inconsistency of results in all comparisons.

These shortcomings need to be taken into consideration when interpreting the results



■ 2016

Background: Two previous systematic reviews describe studies on journal clubs from 1995 to 2007.
Aims: To gather, assess, and synthesize the current empirical evidence on implementation of journal clubs, influencing factors, and outcomes of journal clubs in promoting evidence-based nursing.
Design: A systematic review based on the procedure of the Centre for Reviews and Dissemination.

Data sources and methods: Cochrane, CINAHL, and PubMed Medline databases were sought from 2008 to 2015. The final data consisted of 10 studies. Articles' references were searched manually. The quality appraisal was made according to study design. Data were analyzed by qualitative content analysis and narrative synthesis.

Results: The analyses produced four main categories with 14 subcategories that described the journal clubs: organization, conduct of meetings, influencing factors, and intervention outcomes. Journal clubs had been carried out in a fairly uniform manner in different nursing communities. There remains a lack of evidence on journal clubs' impact on evidence-based nursing (EBN) implementation, which challenges the development of journal clubs' content and methods.

Linking evidence to action: Because journal clubs have achieved a uniform and easy-to-follow manner that is suitable for different nursing contexts and provide multiple positive outcomes, they are recommended for EBN. In work communities, journal clubs should be combined with other well-known factors that promote EBN implementation. The assessment of the outcomes of journal clubs should cover all learning categories of EBN with a focus on medium- to long-term effectiveness. The evaluation of the effectiveness of journal clubs on patient care is of great importance for future studies.



Aim: The aim of this study is to review international scientific articles about pedagogical strategies to teach nursing students at bachelor degree evidence-based practice (EBP).
Method: A literature review including peer reviewed, original, empirical articles describing pedagogical interventions aimed at teaching bachelor's degree nursing students EBP in the period 2004-2014. Theories of discretion, knowledge transfer and cognitive maturity development are used as analytical perspectives.
Results: The main challenge teaching evidence based practice is that the students fail to see how research findings contribute to nursing practice. The pedagogical strategies described are student active learning methods to teach the students information literacy and research topics. Information literacy is mainly taught according to the stages of EBP. These stages focus on how to elaborate evidence from research findings for implementation into nursing practice. The articles reviewed mainly use qualitative, descriptive designs and formative evaluations of the pedagogical interventions.

Conclusion: Although a considerable effort in teaching information literacy and research topics, nursing students still struggle to see the relevance evidence for nursing practice. Before being introduced to information literacy and research topics, students need insight into knowledge transfer and their own epistemic assumptions. Knowledge transfer related to clinical problems should be the learning situations prioritized when teaching EBP at bachelor level. Theoretical perspectives of cognitive maturity development, knowledge transfer and discretion in professional practice give alternative ways of designing pedagogical strategies for EBP. More research is needed to develop and test pedagogical strategies for EBP in light of these theories.



Purpose: The aim of this systematic review was to find best teaching strategies for teaching evidence-based practice (EBP) to undergraduate health students that have been adopted over the last years in healthcare institutions worldwide.
Methods: The authors carried out a systematic, comprehensive bibliographic search using Medline database for the years 2005 to March 2015 (updated in March 2016). Search terms used were chosen from the USNLM Institutes of Health list of MeSH (Medical Subject Headings) and free text key terms were used as well. Selected articles were measured based on the inclusion criteria of this study and initially compared in terms of titles or abstracts. Finally, articles relevant to the subject of this review were retrieved in full text. Critical appraisal was done to determine the effects of strategy of teaching evidence-based medicine (EBM).
Results: Twenty articles were included in the review. The majority of the studies sampled medical students (n=13) and only few conducted among nursing (n=2), pharmacy (n=2), physiotherapy/therapy (n=1), dentistry (n=1), or mixed disciplines (n=1) students. Studies evaluated a variety of educational interventions of varying duration, frequency and format (lectures, tutorials, workshops, conferences, journal clubs, and online sessions), or combination of these to teach EBP. We categorized interventions into single interventions covering a workshop, conference, lecture, journal club, or e-learning and multifaceted interventions where a combination of strategies had been assessed. Seven studies reported an overall increase to all EBP domains indicating a higher EBP competence and two studies focused on the searching databases skill.

Conclusion: Followings were deduced from above analysis: multifaceted approach may be best suited when teaching EBM to health students; the use of technology to promote EBP through mobile devices, simulation, and the web is on the rise; and the duration of the interventions varying form some hours to even months was not related to the students' EBP competence.



Background: Basic skills in evidence-based medicine (EbM) are indispensable for healthcare professionals to promote consumer-centred, evidence-based treatment. EbM training courses are complex interventions - a fact that has not been methodologically reflected by previous systematic reviews. This review evaluates the effects of EbM training for healthcare professionals as well as the quality of reporting of such training interventions.
Methods: We searched PubMed, EMBASE, CINAHL, Cochrane Library, ERIC, Campbell Library and PsycINFO up to 9/2014. Randomised controlled trials, controlled clinical trials as well as before-after trials were included. Authors were contacted in order to obtain missing data. Two independent reviewers extracted data and assessed risk of bias.
Results: We reviewed 14.507 articles; n = 61 appeared potentially eligible; n = 13 involving 1,120 participants were included. EbM training shows some impact on knowledge and skills, whereas the impact on practical EbM application remains unclear. Risk of bias of included trials raises uncertainty about the effects. Description of complex interventions was poor.
Conclusions: EbM training has some positive effects on knowledge and skills of healthcare professionals. Appropriate methods for development, piloting, evaluation, reporting and implementation of the training should be applied.



■ 2014

Background: This literature review on nursing journal clubs evaluates the efficacy of the teaching strategy within the clinical setting.
Method: Peer-reviewed articles were retrieved using an online journal database. Inclusion criteria incorporated information on efficacy of the teaching strategy, evidence-based practices, and continuing education as they related to nursing journal club initiatives.
Results: The literature cited numerous benefits and proved to be in favor of nursing journal clubs. The most common benefits found were nurses remaining abreast of current research, skill development in reading and critically appraising research, and incorporation of evidenice-based practices to patient care. Due to the self-motivated and voluntary nature of this teaching strategy, a limitation commonly identified was lack of participation, and further research on this limitation often was suggested.

Conclusion: Nursing journal clubs proved to be an effective teaching strategy; a finding that remains consistent with the medical pioneers of the movement.



Background: The aim of this systematic review was to identify which information is included when reporting educational interventions used to facilitate foundational skills and knowledge of evidence-based practice (EBP) training for health professionals. This systematic review comprised the first stage in the three stage development process for a reporting guideline for educational interventions for EBP.
Methods: The review question was 'What information has been reported when describing educational interventions targeting foundational evidence-based practice knowledge and skills?'MEDLINE, Academic Search Premier, ERIC, CINAHL, Scopus, Embase, Informit health, Cochrane Library and Web of Science databases were searched from inception until October - December 2011. Randomised and non-randomised controlled trials reporting original data on educational interventions specific to developing foundational knowledge and skills of evidence-based practice were included.Studies were not appraised for methodological bias, however, reporting frequency and item commonality were compared between a random selection of studies included in the systematic review and a random selection of studies excluded as they were not controlled trials. Twenty-five data items were extracted by two independent reviewers (consistency > 90%).
Results: Sixty-one studies met the inclusion criteria (n = 29 randomised, n = 32 non-randomised). The most consistently reported items were the learner's stage of training, professional discipline and the evaluation methods used (100%). The least consistently reported items were the instructor(s) previous teaching experience (n = 8, 13%), and student effort outside face to face contact (n = 1, 2%).

Conclusion: This systematic review demonstrates inconsistencies in describing educational interventions for EBP in randomised and non-randomised trials. To enable educational interventions to be replicable and comparable, improvements in the reporting for educational interventions for EBP are required. In the absence of a specific reporting guideline, there are a range of items which are reported with variable frequency. Identifying the important items for describing educational interventions for facilitating foundational knowledge and skills in EBP remains to be determined. The findings of this systematic review will be used to inform the next stage in the development of a reporting guideline for educational interventions for EBP.



■ 2013

Background: Despite the established interest in evidence-based practice (EBP) as a core competence for clinicians, evidence for how best to teach and evaluate EBP remains weak. We sought to systematically assess coverage of the five EBP steps, review the outcome domains measured, and assess the properties of the instruments used in studies evaluating EBP educational interventions.
Methods: We conducted a systematic review of controlled studies (i.e. studies with a separate control group) which had investigated the effect of EBP educational interventions. We used citation analysis technique and tracked the forward and backward citations of the index articles (i.e. the systematic reviews and primary studies included in an overview of the effect of EBP teaching) using Web of Science until May 2017. We extracted information on intervention content (grouped into the five EBP steps), and the outcome domains assessed. We also searched the literature for published reliability and validity data of the EBP instruments used.
Results: Of 1831 records identified, 302 full-text articles were screened, and 85 included. Of these, 46 (54%) studies were randomised trials, 51 (60%) included postgraduate level participants, and 63 (75%) taught medical professionals. EBP Step 3 (critical appraisal) was the most frequently taught step (63 studies; 74%). Only 10 (12%) of the studies taught content which addressed all five EBP steps. Of the 85 studies, 52 (61%) evaluated EBP skills, 39 (46%) knowledge, 35 (41%) attitudes, 19 (22%) behaviours, 15 (18%) self-efficacy, and 7 (8%) measured reactions to EBP teaching delivery. Of the 24 instruments used in the included studies, 6 were high-quality (achieved ≥3 types of established validity evidence) and these were used in 14 (29%) of the 52 studies that measured EBP skills; 14 (41%) of the 39 studies that measured EBP knowledge; and 8 (26%) of the 35 studies that measured EBP attitude.

Conclusions: Most EBP educational interventions which have been evaluated in controlled studies focus on teaching only some of the EBP steps (predominantly critically appraisal of evidence) and did not use high-quality instruments to measure outcomes. Educational packages and instruments which address all EBP steps are needed to improve EBP teaching.


■ 2012

Introduction: It is essential that allied health practice decisions are underpinned by the best available evidence. Therefore, effective training needs to be provided for allied health professionals to do this. However, little is known about how evidence-based practice training programs for allied health professionals are delivered, the elements contained within them, how learning outcomes are measured or the effectiveness of training components in improving learning outcomes.
Methods: We conducted a systematic literature review to identify effectiveness of evidence-based practice training programs and their components for allied health professionals. Key words of evidence-based practice programs OR journal clubs OR critical appraisal AND allied health OR physiotherapists OR occupational therapists OR speech pathologists AND knowledge OR skills OR attitudes OR behaviour were applied to all available databases. Papers were critically appraised using the Joanna Briggs Institute and McMaster tools and the checklist of recommendations for educational interventions. Data were extracted on participants, training program components and underpinning theories, methods of delivery and learning outcomes. Data were synthesised using a combination of narrative and realist synthesis approaches.
Results: Six relevant studies (four randomised controlled trials and two before-and-after studies) reported on the effectiveness of evidence-based practice training programs for evidence-based practice for groups of health professionals. Specifically, only three of these studies (one randomised controlled trial and two before-and-after studies) reported on allied health professionals (physiotherapists, occupational therapists and social workers). Among these three studies on allied health, outcomes were variably measured, largely reporting on knowledge, skills, attitudes and/or behaviours. Significant changes in knowledge and skills were reported in all studies. Only the social work study, which reassessed outcomes after 3 months, reported significant changes in attitudes and behaviours. Training took from 3 hours to 2 days. While there was information on training program components, there was no evidence of effectiveness related to learning outcomes.

Conclusion: Overall, there is limited research regarding training of allied health professionals in evidence-based practice and learning outcomes. From the limited evidence base, there was consistent evidence that any training significantly influenced knowledge, skills and attitudes, irrespective of the allied health discipline. There was little information, however, regarding how to change or measure behaviours. This review cannot recommend components of training for allied health professionals in evidence-based practice, which significantly improve learning outcomes.



■ 2011

Background: Journal clubs (JCs) are a common form of interactive education in health care aiming to promote the uptake of research evidence into practice, but their effectiveness has not been established.
Objective: This systematic review aimed to determine whether the JC is an effective intervention in supporting clinical decision making.
Methods: We searched for studies which evaluated whether clubs promote changes in learner reaction, attitudes, knowledge, skills, behaviour or patient outcomes. We included undergraduate, postgraduate and practice JCs and excluded studies evaluating video/internet meetings or single meetings.

Results: Eighteen studies were included. Studies reported improvements in reading behaviour (N = 5/11), confidence in critical appraisal (N = 7/7), critical appraisal test scores (N = 5/7) and ability to use findings (N = 5/7). No studies reported on patient outcomes. Sixteen studies used self-reported measures, but only four studies used validated tests. Interventions were too heterogeneous to allow pooling. Realist synthesis identified potentially 'active educational ingredients', including mentoring, brief training in clinical epidemiology, structured critical appraisal tools, adult-learning principles, multifaceted teaching approaches and integration of the JC with other clinical and academic activities.

Conclusion: The effectiveness of JCs in supporting evidence-based decision making is not clear. Better reporting of the intervention and a mixed methods approach to evaluating active ingredients are needed in order to understand how JCs may support evidence-based practice.


Background: Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. This is an update of a Cochrane review first published in 2001.
Objectives: To assess the effects of teaching critical appraisal skills to health professionals on the process of care, patient outcomes and knowledge of health professionals. SEARCH METHODS. We updated the search (see Appendix 1 for search strategies by database) and used those search strategies to search the Cochrane Central Register of Controlled Trials (1997 to June 2011) and MEDLINE (from 1997 to June 2011). We also searched EMBASE, CINAHL and PsycINFO (up to January 2010). We searched LISA (up to January 2010), ERIC (up to January 2010), SIGLE (up to January 2010) and Web of Knowledge (up to January 2010). We also searched the Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register up to January 2010.
Selection criteria: Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series analyses that examined the effectiveness of educational interventions teaching critical appraisal to health professionals. The outcomes included process of care, patient mortality, morbidity, quality of life and satisfaction. We included studies reporting on health professional knowledge/awareness only when based upon objective, standardised, validated instruments. We did not consider studies involving students.

Data collection and analysis: Two review authors independently extracted data and assessed risk of bias. We contacted authors of included studies to obtain missing data.

Main results: In total, we reviewed a total of 11,057 titles and abstracts, of which 148 appeared potentially relevant to the review. We included three studies involving 272 people in this review. None of the included studies evaluated process of care or patient outcomes. Statistically significant improvements in participants' knowledge were reported in domains of critical appraisal (variable approaches across studies) in two of the three studies. We determined risk of bias to be 'unclear' and as such considered this to be 'plausible bias that raises some doubt about the results'.

Authors' conclusions: Low-intensity critical appraisal teaching interventions in healthcare populations may result in modest gains. Improvements to research examining the effectiveness of interventions in healthcare populations are required; specifically rigorous randomised trials employing interventions using appropriate adult learning theories.



初回作成：2024/8/5