Ability of an information mastery curriculum to improve residents' skills and attitudes.

BACKGROUND AND OBJECTIVES Teaching evidence-based medicine is becoming more frequent in family medicine residency education, as is the teaching of information mastery, which is using techniques to answer clinical questions at the point of care and to keep up with changes in medical knowledge. The goal of this study was to determine the effect of an integrated curriculum of information mastery on residents' evidence-based medicine knowledge and skills as well as their confidence at critically appraising medical literature and using evidence to inform clinical decisions. METHODS We used a before-after study in a single residency over 5 years. Residents completed the Fresno Test of Evidence-based Medicine and an attitude questionnaire at the start of the curriculum and then again before graduation. The integrated curriculum consisted of intensive instruction over the course of 1 month (30 hours), followed by a longitudinal series of ongoing conferences, integrated into the teaching of clinical content. Teaching was also integrated into day-to-day clinical activities via precepting interactions. RESULTS Twenty-three residents completed the study. Modified Fresno Test scores significantly improved from 104.0 to 121.5. Using a pass/fail approach, nine residents (40.1%) passed the test at the start of training, increasing to 17 (73.4%) at the end of the intervention. Confidence in critical appraisal scores increased from an average 17.90 (95% CI=16.55--19.25) to 21.10 (95% CI=19.49--22.71), out of a possible score of 25. Confidence scores were significantly lower in residents who did not pass the posttest (18.5 versus 21.9). Attitudes regarding confidence in the use of evidence and a decreased reliance on experts were also improved following the curriculum. CONCLUSIONS A curriculum of information mastery, integrated across the greater curriculum, improved trainees' evidence-based medicine knowledge and skills and attitude toward using evidence to inform clinical decision making.