An evidence-based medicine curriculum implemented in journal club improves resident performance on the Fresno test.

BACKGROUND: Journal club is a standard component of residency education. Journal club focuses on review and interpretation of the medical literature with varying degrees of evidence-based medicine (EBM) education. OBJECTIVES: To evaluate learning of EBM principles with an EBM curriculum implemented as a component of journal club. EBM competency was established using the Fresno test, a validated 12-question instrument of short-answer and essay-style questions to assess competency in EBM. METHODS: An EBM curriculum was implemented that consisted of a focus on EBM topics (e.g., study validity, bias, confidence intervals, search strategies) using a structured journal club format using a peer instruction model. The Fresno test was used prior to and after the implementation of the first year of this curriculum to measure effectiveness of the intervention. A hierarchical multivariable model using generalized estimating equations was used to account for repeated measures in the primary outcome of change in total Fresno test score. RESULTS: The total test scores did not increase significantly (105.4 vs. 120.9, p = 0.058) in the before-after analysis. The only subscore showing improvement was interpretation of study validity (32.1 vs. 40.4 points, p = 0.03). Attendance was significantly associated with Fresno test score, with those attending ≥ 6/11 sessions (55%) scoring 28.2 points higher (p = 0.003), and those attending fewer than six sessions scoring only 1.9 points higher (p = 0.81) than in the preintervention group. CONCLUSION: An EBM curriculum implemented as part of journal club improves performance on the Fresno test among residents who attended at least six journal club sessions.

Comparison of postsimulation debriefing versus in-simulation debriefing in medical simulation.

INTRODUCTION: A key portion of medical simulation is self-reflection and instruction during a debriefing session; however, there have been surprisingly few direct comparisons of various approaches. The objective of this study was to compare two styles of managing a simulation session: postsimulation debriefing versus in-simulation debriefing. METHODS: One hundred sixty-one students were randomly assigned to receive either postsimulation debriefing or in-simulation debriefing. Retrospective pre-post assessment was made through survey using Likert-scale questions assessing students' self-reported confidence and knowledge level as it relates to medical resuscitation and statements related to the simulation itself. RESULTS: There were statistically significant differences in the reliable self-reported results between the two groups for effectiveness of the debriefing style, debriefing leading to effective learning, and the debriefing helping them to understand the correct and incorrect actions, with the group that received postsimulation debriefing ranking all these measures higher. Both groups showed significantly higher posttest scores compared with their pretest scores for individual and overall measures. DISCUSSION: Students felt that a simulation experience followed by a debriefing session helped them learn more effectively, better understand the correct and incorrect actions, and was overall more effective compared with debriefing that occurred in-simulation. Students did not feel that interruptions during a simulation significantly altered the realism of the simulation.