• 四川大學華西醫(yī)院循證醫(yī)學與臨床流行病學中心(成都610041);

目的 　探討循證醫(yī)學課程對醫(yī)學研究生知識、技能、態(tài)度和行為的影響以及循證臨床實踐中的障礙，為進一步有效地開展循證醫(yī)學教學和循證臨床實踐提供參考。
方法 　采用封閉式問題和開放式問題相結合的自填問卷對四川大學2004年秋選修《循證醫(yī)學》的111名醫(yī)學研究生進行調查，比較選修前后學生在循證醫(yī)學知識、技能、態(tài)度、行為，以及循證臨床實踐中障礙方面的差異。
結果 　醫(yī)學研究生在選修“循證醫(yī)學”課程前后，其循證醫(yī)學知識、技能、態(tài)度、行為，以及在循證臨床實踐的障礙方面有一定差異。在知識和技能方面：選修后學生對循證醫(yī)學相關專業(yè)術語的理解有顯著提高（75%項目差異有統(tǒng)計學意義），特別是對絕對危險度、系統(tǒng)評價、Meta分析和發(fā)表偏倚（P lt;0.01）；認為自己在熟練使用檢索工具這一技能上有所提高（P lt;0.05）。在態(tài)度方面：選修前，有55%左右的條目分值均較高（ gt;4分）；選修后“現在多數用于病人診治的干預措施缺乏強有力的證據支持”和“循證醫(yī)學實踐需要考慮病人的意愿”這兩項分值提高明顯（P lt;0.01）?！霸卺t(yī)療實踐中采用循證醫(yī)學是合理的要求”和“循證醫(yī)學不受臨床實踐場所的限制”這兩個條目選修前后的分值都偏低（ lt;3分），在“日常工作中需要增加醫(yī)學證據的使用”和“對應用循證醫(yī)學進行臨床實踐和改進臨床技能有興趣”兩項上，分值接近。在行為方面：選修后醫(yī)學生對文獻的使用仍不十分重視。如選修前后都有60%左右的醫(yī)學生基本上不閱讀相關的專業(yè)文獻。雖然檢索MEDLINE和其他電子數據庫次數較多（ gt;6次/月，選修前60.3%，選修后65.7%），但在臨床實踐中應用卻不多（ gt;6次/月，課前僅占29%,課后僅占35.1%）。學生對臨床實踐指南的應用情況，選修前后差異無統(tǒng)計學意義。在障礙方面：選修前后學生均認為最大的障礙是嚴格評價文獻的能力有限，但排名第2與第3的障礙有差別。選修前缺乏查詢循證醫(yī)學的相關技能排在缺乏信息資源前，而選修后相反。
結論 　目前的循證醫(yī)學課程對提高醫(yī)學研究生循證醫(yī)學知識的效果顯著，對其對待循證醫(yī)學的態(tài)度和行為也有一定的提高。在臨床實踐中，醫(yī)學研究生應用循證醫(yī)學的三大障礙是嚴格評價文獻能力有限，缺乏查詢循證醫(yī)學相關的技能和缺乏信息資源。

引用本文： 周麗萍,陳進,艾昌林,劉關鍵,李靜,康德英,王莉. 循證醫(yī)學教學對研究生相關知識、技能、態(tài)度和行為的影響研究. 中國循證醫(yī)學雜志, 2007, 07(5): 337-343. doi: 復制

1. Chen J, Li J, Li YP. Teaching Evidence-Based Medicine: a New Practice in Medical Education. Chin J Evid-based Med, 2003, 3(4): 273-276.
2. Chen J, Li YP, Li J. Method of teaching evidence-based medicine in medical postgraduates--examination paper analysis. Chin J Evid-Based Med, 2005, 5(7): 511-514, 561.
3. 陳進, 李靜, 李幼平. 循證醫(yī)學教學—高等醫(yī)學創(chuàng)新教育實踐. 中國循證醫(yī)學雜志, 2003, 3(4): 273-276.
4. 陳進, 李幼平, 李靜. 從考試改革探索循證醫(yī)學教學方法. 中國循證醫(yī)學雜志, 2005, 5(7): 511-514, 561.
5. Fritsche L, Greenhalgh T, Falck-Ytter Y, et al. Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ, 2002, 325(7376): 1338-1341.
6. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ, 2004; 329(7473): 1017.
7. Bradley DR, Rana GK, Martin PW, et al. Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit. J Med Libr Assoc, 2002, 90(2): 194-201.
8. Khan KS, Pakkal M, Brace V, et al. Postgraduate journal club as a means of promoting evidence-based obstetrics and gynaecology. J Obstet Gynaecol, 1999, 19(3): 231-234.
9. Landry FJ, Pangaro L, Kroenke K, et al. A controlled trial of a seminar to improve medical student attitudes toward, knowledge about, and use of the medical literature. J Gen Intern Med, 1994, 9(8): 436-439.
10. Haines SJ, Nicholas JS. Teaching evidence-based medicine to surgical subspecialty residents. J Am Coll Surg, 2003, 197(2): 285-289.
11. Ely JW, Osheroff JA, Ebell MH, et al. Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ, 2002, 324(7339): 710.
12. Sackett DL, Richardson WS, Rosenberg W, et al. Evidence-based medicine: how to practice and teach EBM. 2nd edition. Churchill Livingstone. London, 2000.
13. Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidence­based medicine) skills: a critical appraisal. CMAJ, 1998, 158: 177­81.
14. Green ML. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence­based medicine: a critical review of curricula. Acad Med, 1999, 74: 686­94.
15. Parkes J, Hyde C, Deeks J, et al. Teaching critical appraisal skills in health care settings. In: Cochrane Library. Issue 3. Oxford: Update Software, 2001.
16. Taylor R, Reeves B, Ewings P, et al. A systematic review of the effectiveness of critical appraisal skills training for clinicians. Med Educ, 2000, 34: 120­5.
17. Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med, 1998, 13: 347­53.
  1. 1. Chen J, Li J, Li YP. Teaching Evidence-Based Medicine: a New Practice in Medical Education. Chin J Evid-based Med, 2003, 3(4): 273-276.
  2. 2. Chen J, Li YP, Li J. Method of teaching evidence-based medicine in medical postgraduates--examination paper analysis. Chin J Evid-Based Med, 2005, 5(7): 511-514, 561.
  3. 3. 陳進, 李靜, 李幼平. 循證醫(yī)學教學—高等醫(yī)學創(chuàng)新教育實踐. 中國循證醫(yī)學雜志, 2003, 3(4): 273-276.
  4. 4. 陳進, 李幼平, 李靜. 從考試改革探索循證醫(yī)學教學方法. 中國循證醫(yī)學雜志, 2005, 5(7): 511-514, 561.
  5. 5. Fritsche L, Greenhalgh T, Falck-Ytter Y, et al. Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ, 2002, 325(7376): 1338-1341.
  6. 6. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ, 2004; 329(7473): 1017.
  7. 7. Bradley DR, Rana GK, Martin PW, et al. Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit. J Med Libr Assoc, 2002, 90(2): 194-201.
  8. 8. Khan KS, Pakkal M, Brace V, et al. Postgraduate journal club as a means of promoting evidence-based obstetrics and gynaecology. J Obstet Gynaecol, 1999, 19(3): 231-234.
  9. 9. Landry FJ, Pangaro L, Kroenke K, et al. A controlled trial of a seminar to improve medical student attitudes toward, knowledge about, and use of the medical literature. J Gen Intern Med, 1994, 9(8): 436-439.
  10. 10. Haines SJ, Nicholas JS. Teaching evidence-based medicine to surgical subspecialty residents. J Am Coll Surg, 2003, 197(2): 285-289.
  11. 11. Ely JW, Osheroff JA, Ebell MH, et al. Obstacles to answering doctors’ questions about patient care with evidence: qualitative study. BMJ, 2002, 324(7339): 710.
  12. 12. Sackett DL, Richardson WS, Rosenberg W, et al. Evidence-based medicine: how to practice and teach EBM. 2nd edition. Churchill Livingstone. London, 2000.
  13. 13. Norman GR, Shannon SI. Effectiveness of instruction in critical appraisal (evidence­based medicine) skills: a critical appraisal. CMAJ, 1998, 158: 177­81.
  14. 14. Green ML. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence­based medicine: a critical review of curricula. Acad Med, 1999, 74: 686­94.
  15. 15. Parkes J, Hyde C, Deeks J, et al. Teaching critical appraisal skills in health care settings. In: Cochrane Library. Issue 3. Oxford: Update Software, 2001.
  16. 16. Taylor R, Reeves B, Ewings P, et al. A systematic review of the effectiveness of critical appraisal skills training for clinicians. Med Educ, 2000, 34: 120­5.
  17. 17. Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med, 1998, 13: 347­53.