Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

M.F. Kortekaas; M.E.L. Bartelink; N.P.A. Zuithoff; G.J.M.G. van der Heijden; N.J. de Wit; A.W. Hoes

doi:10.1136/bmjopen-2015-010537

Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

M.F. Kortekaas, M.E.L. Bartelink, N.P.A. Zuithoff, G.J.M.G. van der Heijden, N.J. de Wit, A.W. Hoes

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objectives

Evidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice.

Setting

GP specialty training in the Netherlands.

Participants

All 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group.

Intervention

Integrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations.

Comparison

Stand-alone EBM training at the institute only.

Primary and secondary outcomes

Our primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models.

Results

Logbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively.

Conclusions

Integrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs.

Original language	English
Article number	e010537
Number of pages	12
Journal	BMJ Open
Volume	6
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2015-010537
Publication status	Published - Sept 2016

Bibliographical note

With online supplementary appendix

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Kortekaas, M. F., Bartelink, M. E. L., Zuithoff, N. P. A., van der Heijden, G. J. M. G., de Wit, N. J., & Hoes, A. W. (2016). Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial. BMJ Open, 6(9), Article e010537. https://doi.org/10.1136/bmjopen-2015-010537

@article{8e0d10ce78cf4d8a98db193e14077aca,

title = "Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial",

abstract = "ObjectivesEvidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. SettingGP specialty training in the Netherlands.ParticipantsAll 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group.InterventionIntegrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations.ComparisonStand-alone EBM training at the institute only.Primary and secondary outcomesOur primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models.ResultsLogbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively.ConclusionsIntegrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs.",

author = "M.F. Kortekaas and M.E.L. Bartelink and N.P.A. Zuithoff and {van der Heijden}, G.J.M.G. and {de Wit}, N.J. and A.W. Hoes",

note = "With online supplementary appendix",

year = "2016",

month = sep,

doi = "10.1136/bmjopen-2015-010537",

language = "English",

volume = "6",

journal = "BMJ Open",

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Kortekaas, MF, Bartelink, MEL, Zuithoff, NPA, van der Heijden, GJMG, de Wit, NJ & Hoes, AW 2016, 'Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial', BMJ Open, vol. 6, no. 9, e010537. https://doi.org/10.1136/bmjopen-2015-010537

Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial. / Kortekaas, M.F.; Bartelink, M.E.L.; Zuithoff, N.P.A. et al.
In: BMJ Open, Vol. 6, No. 9, e010537, 09.2016.

Research output: Contribution to Journal › Article › Academic › peer-review

TY - JOUR

T1 - Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

AU - Kortekaas, M.F.

AU - Bartelink, M.E.L.

AU - Zuithoff, N.P.A.

AU - van der Heijden, G.J.M.G.

AU - de Wit, N.J.

AU - Hoes, A.W.

N1 - With online supplementary appendix

PY - 2016/9

Y1 - 2016/9

N2 - ObjectivesEvidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. SettingGP specialty training in the Netherlands.ParticipantsAll 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group.InterventionIntegrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations.ComparisonStand-alone EBM training at the institute only.Primary and secondary outcomesOur primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models.ResultsLogbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively.ConclusionsIntegrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs.

AB - ObjectivesEvidence-based medicine (EBM) is an important element in the general practice (GP) specialty training. Studies show that integrating EBM training into clinical practice brings larger benefits than stand-alone modules. However, these studies have neither been performed in GP nor assessed EBM behaviour of former trainees in daily clinical practice. SettingGP specialty training in the Netherlands.ParticipantsAll 82 third year GP trainees who started their final third year in 2011 were approached for inclusion, of whom 79 (96%) participated: 39 in the intervention group and 40 in the control group.InterventionIntegrated EBM training, in which EBM is embedded closely within the clinical context by joint assignments for the trainee and supervisor in daily practice, and teaching sessions based on dilemmas from actual patient consultations.ComparisonStand-alone EBM training at the institute only.Primary and secondary outcomesOur primary outcome was EBM behaviour, assessed by measuring guideline adherence (incorporating rational, motivated deviation) and information-seeking behaviour. Our secondary outcomes were EBM attitude and EBM knowledge. Data were acquired using logbooks and questionnaires, respectively. Analyses were performed using mixed models.ResultsLogbook data were available from 76 (96%) of the participating trainees at baseline (7614 consultations), 60 (76%) at the end of the third year (T1, 4973 consultations) and 53 (67%) 1 year after graduation (T2, 3307 consultations). We found no significant differences in outcomes between the 2 groups, with relative risks for guideline adherence varying between 0.96 and 0.99 (95% CI 0.86 to 1.11) at T1, and 0.99 and 1.10 (95% CI 0.92 to 1.25) at T2, and for information-seeking behaviour between 0.97 and 1.16 (95% CI 0.70 to 1.91) and 0.90 and 1.10 (95% CI 0.70 to 1.32), respectively.ConclusionsIntegrated EBM training compared with stand-alone EBM training does not improve EBM behaviour, attitude or knowledge of (future) GPs.

U2 - 10.1136/bmjopen-2015-010537

DO - 10.1136/bmjopen-2015-010537

M3 - Article

SN - 2044-6055

VL - 6

JO - BMJ Open

JF - BMJ Open

IS - 9

M1 - e010537

ER -

Does integrated training in evidence-based medicine (EBM) in the general practice (GP) specialty training improve EBM behaviour in daily clinical practice? A cluster randomised controlled trial

Abstract

Bibliographical note

UN SDGs

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