Pediatric residents as learners and teachers of evidence-based medicine

Residents must learn to assess the medical literature and apply it clinically. We designed and implemented a curriculum to support resident acquisition and use of skills required for critical review and clinical application of evidence from the pediatrics literature. The experience provided an opportunity for residents to observe, demonstrate under supervision, and practice evidence-based skills using the "see one, do one, practice many" approach.

We revised our residents' evidence-based pediatrics journal club curriculum to provide specific learning objectives to be accomplished by residents during the three years of residency. Curriculum objectives address study design, definition of the research question, characterization of variable type and choices of statistical methods, attention to sample size, diagnostic test characteristics, identification of sources of bias, and generalization and specific application of research findings to our clinical setting. We implemented a three-stage approach to skills learning. First-year residents participate in a monthly journal-club presented by the second-year residents ("see one"). During the second year, residents present noon conferences based on the curriculum objectives. The second-year resident meets with a faculty member to select a journal article for discussion, identify key curriculum objectives illustrated by the study, and choose pertinent clinical epidemiology references. The resulting presentation is given as a noon conference to an audience of residents, students, and faculty ("do one"). During the remainder of residency, residents continue to attend a monthly journal club that equips them with new skills and allows them to take a more meaningful part in the discussions ("practice many"). Curriculum faculty attend the monthly journal club to help direct the discussion of the article to fulfill curriculum objectives.

Skills are best acquired in an environment which promotes active learning supervised by experts and provides frequent opportunities to practice the skills. Residents have responded positively to our curriculum and have presented high-quality conferences. Evaluation data being collected now (resident self-assessments and evaluations of the experience, faculty assessments of presentations, pre- and post-second year written assessments of knowledge) will inform us if the desired outcomes are being attained. Over the first two years of implementation of this curriculum, we have observed that it takes no more faculty time to supervise resident preparation and presentation than it would for the faculty to prepare and present material concerning similar curriculum objectives in a lecture or conference format. Additional benefits for residents include creating materials for presentation with experienced faculty, making presentations for peer groups, and assuming the role of teacher.