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Does evidence-based medicine training improve doctors’ knowledge, practice and patient outcomes? A systematic review of the evidence

机译：基于证据的医学培训是否改善了医生的知识，实践和患者结果？ 系统审查证据

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Courses in Evidence-Based Medicine (EBM) for doctors have consistently demonstrated short-term improvements in knowledge. However, there is no strong evidence linking EBM training to changes in clinical practice or patient outcomes. This systematic review investigates whether EBM training leads to sustained improvements in doctors’ knowledge and practice behaviors that may also facilitate changes in patient outcomes and experiences. A literature search was undertaken in Ovid Medline, Ovid Embase, The Cochrane Library, ERIC and Scopus. Studies published from 1997 to 2016 that assessed outcomes of EBM educational interventions amongst doctors and used measures of knowledge, skills, attitudes, practice or patient outcomes were included. Fifteen studies were included in the analysis: four randomized controlled trials (RCTs), three non-RCTs, and eight before-after (longitudinal cohort) studies. Heterogeneity among studies prevented meaningful comparisons. Varying degrees of bias due to the use of subjective measures were identified, limiting study validity. Results showed that EBM interventions can improve short-term knowledge and skills, but there is little reliable evidence of changes in long-term knowledge, attitudes, and clinical practice. No study measured improvement in patient outcomes or experiences. EBM training for medical practitioners needs to incorporate measures of behavioral changes while incorporating patient outcomes and experience measures.
机译：医生循证医学课程（EBM）一直表明知识的短期改善。但是，没有强有力的证据将EBM培训与临床实践或患者结果的变化联系起来。这种系统审查调查了EBM培训是否导致医生知识和实践行为的持续改进，这些行为也可能促进患者结果和经验的变化。文献搜索是在ovid Medline，Ovid Embase，Cochrane图书馆，埃里克和Scopus中进行的。从1997年到2016年出版的研究，包括医生和使用的知识，技能，态度，实践或患者结果的医生和使用措施的EBM教育干预措施。分析中包含十五项研究：四项随机对照试验（RCT），三个非RCT和8次前后（纵向队列）研究。研究中的异质性阻止了有意义的比较。确定了由于使用主观措施而产生的不同程度的偏见，限制了研究有效性。结果表明，EBM干预措施可以提高短期知识和技能，但几乎没有可靠的证据，即长期知识，态度和临床实践的变化。没有研究患者结果或经验的改善。用于医生的EBM培训需要纳入行为变化的措施，同时纳入患者结果和经验措施。

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