Evidenzbasierte Medizin online zum ärztlichen Berufsstart– eine randomisiert-kontrollierte Studie

Abstract

Introduction:
 Evidence-based Medicine (EbM) was originally developed as a teaching tool for young doctors, but in Germany the last surveys among residents in 2009 and 2011 demonstrated that, across all topics, the largest deficits were seen in the field of EbM. One reason may be a deficit in customised offers for continuing medical education in EbM. In a randomised controlled trial with a wait-control design we investigated a possible gain in knowledge and the acceptance of an online course in EbM for first-year residents.
 Methods:
 All first-year residents at the Hospital of the Goethe University in Frankfurt received the offer to voluntarily take part in an online EbM course. The tutored course consisted of five modules according to the five steps of EbM, each module being complemented by practical tasks. The participants were randomised via telephone to the course right away or after a three-month waiting period. The primary endpoint (i.e., knowledge) was tested via two sets of 13 multiple choice questions before and after the course and after 6 and 12 months. The participants were asked to subjectively evaluate the course by using an A-F grading system and to semiquantitatively assess its level of difficulty; they were also asked to evaluate the usefulness of its content in their clinical setting.
 Results:
 114 out of the 120 randomised participants took part. After 3 months the immediate intervention group (n=58) achieved a median of 10 (95 % confidence interval 10 to 11) correct answers following the course, whereas the waiting intervention group only received a median of 4 (95% confidence interval 4 to 5) correct answers after the three month waiting period (p ≤ 0.0001). The median gain in knowledge for both groups throughout the course was 5 correct answers (p ≤ 0.0001), and this proved to remain constant within a twelve month period. Six months after the course, this course was rated as clinically useful by 96.4 % of the participants, and 38.1% stated that they would volunteer again in further teaching activities. The course received a median grade of B.
 Discussion and conclusions:
 A German online EbM course for first-year residents leads to a remarkable and sustainable gain in knowledge, is well marked, and its contents were regarded as clinically relevant. This tutored practical course is applicable to various settings and could provide an important contribution to EbM residency programs.