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The evidence-based medicine (EBM) curriculum in the School of Medicine is integrated into the first three years of medical school. EBM assignments and relevant references are posted on the electronic curriculum, and students are encouraged to attend workshops regarding these assignments.
The SOM looks to the Association of American Medical Colleges (AAMC) medical informatics objectives (based on EBM) and to the six key SOM objectives to guide CBIL's operations. The SOM objectives state that medical students should be able to: access computer-based instruction for self-study learning in medical education; search the medical literature using MEDLINE, MICROMEDEX and other online full text and bibliographic systems; utilize diagnostic decision-support systems as an additional method of learning medical diagnosis and problem solving; utilize email, the Internet, and other online information resources to obtain information quickly and efficiently; utilize patient information systems to manage medical records in the practice of medicine; and develop proficiency in completing computerized examinations.
Integration of EBM skills begins during the M-I Genetics course, which starts in the fall of the first year of medical school. The students are assigned a genetic syndrome to research, and they are to develop and produce a patient brochure on the topic.
There are two EBM assignments in the M-II Foundations of Clinical Medicine course, one during the fall semester and another in the spring. The first assignment requires students to find a recent, relevant, review article on a topic related to a patient they have conducted a history and physical (H & P) on during a visit with community based general medical practitioner or preceptor. CBIL and library faculty teach small group sessions on efficient searching of PubMed and how to find online articles. The second EBM assignment coincides with the students' visits to a long term care facility. Students conduct an H & P on an elderly patient and get a complete list of medications for the patient.
There is a mini case, requiring a literature search, on the computerized examination at the end of the M-II Foundations of Clinical Medicine course. Students are randomly assigned one of 15 cases, which they are required to diagnose and on which they must conduct a PubMed search.
The points of EBM integration in the M-III year are during the Internal Medicine (IM) and Family Medicine (FM) clerkships. In the IM clerkship, students attend a one hour tutorial session conducted by CBIL and TML faculty where they review the development of a good clinical question and how to complete an efficient search on PubMed. Students are introduced to the Cochrane Library and learn to search the Cochrane Collection. Students learn how to judge the validity of an article and are asked to find a randomized, controlled trial (best evidence) on a topic related to a geriatric patient they have seen during their medicine rotation. The FM clerkship students complete an EBM project on a topic approved by their preceptor. Potential projects include a patient brochure, a presentation to the office staff, a talk to a local community group or school, or a practice improvement initiative. CBIL staff evaluates the statement of relevance to Family Medicine, organization of content, audience-appropriate level, and references meeting POEM criteria.
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