What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review

OBJECTIVE: To evaluate the effects of standalone versus clinically integrated teaching in evidence based medicine on various outcomes in postgraduates. DESIGN: Systematic review of randomised and non-randomised controlled trials and before and after comparison studies. DATA SOURCES: Medline, Embase, ERIC, Cochrane Library, DARE, HTA database, Best Evidence, BEME, and SCI. STUDY SELECTION: 23 studies: four randomised trials, seven non-randomised controlled studies, and 12 before and after comparison studies. 18 studies (including two randomised trials) evaluated a standalone teaching method, and five studies (including two randomised trials) evaluated a clinically integrated teaching method. MAIN OUTCOME MEASURES: Knowledge, critical appraisal skills, attitudes, and behaviour. RESULTS: Standalone teaching improved knowledge but not skills, attitudes, or behaviour. Clinically integrated teaching improved knowledge, skills, attitudes, and behaviour. CONCLUSION: Teaching of evidence based medicine should be moved from classrooms to clinical practice to achieve improvements in substantial outcomes.