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

目的 　探討循證醫(yī)學(xué)課程對(duì)醫(yī)學(xué)研究生知識(shí)、技能、態(tài)度和行為的影響以及循證臨床實(shí)踐中的障礙，為進(jìn)一步有效地開展循證醫(yī)學(xué)教學(xué)和循證臨床實(shí)踐提供參考。
方法 　采用封閉式問題和開放式問題相結(jié)合的自填問卷對(duì)四川大學(xué)2004年秋選修《循證醫(yī)學(xué)》的111名醫(yī)學(xué)研究生進(jìn)行調(diào)查，比較選修前后學(xué)生在循證醫(yī)學(xué)知識(shí)、技能、態(tài)度、行為，以及循證臨床實(shí)踐中障礙方面的差異。
結(jié)果 　醫(yī)學(xué)研究生在選修“循證醫(yī)學(xué)”課程前后，其循證醫(yī)學(xué)知識(shí)、技能、態(tài)度、行為，以及在循證臨床實(shí)踐的障礙方面有一定差異。在知識(shí)和技能方面：選修后學(xué)生對(duì)循證醫(yī)學(xué)相關(guān)專業(yè)術(shù)語的理解有顯著提高（75%項(xiàng)目差異有統(tǒng)計(jì)學(xué)意義），特別是對(duì)絕對(duì)危險(xiǎn)度、系統(tǒng)評(píng)價(jià)、Meta分析和發(fā)表偏倚（P lt;0.01）；認(rèn)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(xiàn)在多數(shù)用于病人診治的干預(yù)措施缺乏強(qiáng)有力的證據(jù)支持”和“循證醫(yī)學(xué)實(shí)踐需要考慮病人的意愿”這兩項(xiàng)分值提高明顯（P lt;0.01）。“在醫(yī)療實(shí)踐中采用循證醫(yī)學(xué)是合理的要求”和“循證醫(yī)學(xué)不受臨床實(shí)踐場(chǎng)所的限制”這兩個(gè)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(xué)證據(jù)的使用”和“對(duì)應(yīng)用循證醫(yī)學(xué)進(jìn)行臨床實(shí)踐和改進(jìn)臨床技能有興趣”兩項(xiàng)上，分值接近。在行為方面：選修后醫(yī)學(xué)生對(duì)文獻(xiàn)的使用仍不十分重視。如選修前后都有60%左右的醫(yī)學(xué)生基本上不閱讀相關(guān)的專業(yè)文獻(xiàn)。雖然檢索MEDLINE和其他電子數(shù)據(jù)庫次數(shù)較多（ gt;6次/月，選修前60.3%，選修后65.7%），但在臨床實(shí)踐中應(yīng)用卻不多（ gt;6次/月，課前僅占29%,課后僅占35.1%）。學(xué)生對(duì)臨床實(shí)踐指南的應(yīng)用情況，選修前后差異無統(tǒng)計(jì)學(xué)意義。在障礙方面：選修前后學(xué)生均認(rèn)為最大的障礙是嚴(yán)格評(píng)價(jià)文獻(xiàn)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(xué)的相關(guān)技能排在缺乏信息資源前，而選修后相反。
結(jié)論 　目前的循證醫(yī)學(xué)課程對(duì)提高醫(yī)學(xué)研究生循證醫(yī)學(xué)知識(shí)的效果顯著，對(duì)其對(duì)待循證醫(yī)學(xué)的態(tài)度和行為也有一定的提高。在臨床實(shí)踐中，醫(yī)學(xué)研究生應(yīng)用循證醫(yī)學(xué)的三大障礙是嚴(yán)格評(píng)價(jià)文獻(xiàn)能力有限，缺乏查詢循證醫(yī)學(xué)相關(guān)的技能和缺乏信息資源。

引用本文： 周麗萍,陳進(jìn),艾昌林,劉關(guān)鍵,李靜,康德英,王莉. 循證醫(yī)學(xué)教學(xué)對(duì)研究生相關(guān)知識(shí)、技能、態(tài)度和行為的影響研究. 中國循證醫(yī)學(xué)雜志, 2007, 07(5): 337-343. doi: 復(fù)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(jìn), 李靜, 李幼平. 循證醫(yī)學(xué)教學(xué)—高等醫(yī)學(xué)創(chuàng)新教育實(shí)踐. 中國循證醫(yī)學(xué)雜志, 2003, 3(4): 273-276.
4. 陳進(jìn), 李幼平, 李靜. 從考試改革探索循證醫(yī)學(xué)教學(xué)方法. 中國循證醫(yī)學(xué)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(jìn), 李靜, 李幼平. 循證醫(yī)學(xué)教學(xué)—高等醫(yī)學(xué)創(chuàng)新教育實(shí)踐. 中國循證醫(yī)學(xué)雜志, 2003, 3(4): 273-276.
  4. 4. 陳進(jìn), 李幼平, 李靜. 從考試改革探索循證醫(yī)學(xué)教學(xué)方法. 中國循證醫(yī)學(xué)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.