Does evidence-based medicine training improve doctors’ knowledge, practice and patient outcomes? A systematic review of the evidence

Courses in Evidence-Based Medicine (EBM) for doctors have consistently demonstrated short-term improvements in knowledge. However, there is no strong evidence linking EBM training to changes in clinical practice or patient outcomes. This systematic review investigates whether EBM training leads to sustained improvements in doctors’ knowledge and practice behaviors that may also facilitate changes in patient outcomes and experiences. A literature search was undertaken in Ovid Medline, Ovid Embase, The Cochrane Library, ERIC and Scopus. Studies published from 1997 to 2016 that assessed outcomes of EBM educational interventions amongst doctors and used measures of knowledge, skills, attitudes, practice or patient outcomes were included. Fifteen studies were included in the analysis: four randomized controlled trials (RCTs), three non-RCTs, and eight before-after (longitudinal cohort) studies. Heterogeneity among studies prevented meaningful comparisons. Varying degrees of bias due to the use of subjective measures were identified, limiting study validity. Results showed that EBM interventions can improve short-term knowledge and skills, but there is little reliable evidence of changes in long-term knowledge, attitudes, and clinical practice. No study measured improvement in patient outcomes or experiences. EBM training for medical practitioners needs to incorporate measures of behavioral changes while incorporating patient outcomes and experience measures.

针对医师的循证医学（Evidence-Based Medicine, EBM）培训课程，已被证实可在短期内提升医师的知识储备。然而目前尚无确凿证据表明，循证医学培训可推动临床实践变革或改善患者结局。本系统综述旨在探究循证医学培训是否能使医师的知识与执业行为得到持续改善，并进而推动患者结局与就医体验的优化。本研究通过Ovid Medline、Ovid Embase、Cochrane图书馆、ERIC及Scopus数据库开展文献检索，最终纳入1997年至2016年间发表的、针对医师群体的循证医学教育干预结局评估研究，且研究需采用知识、技能、态度、临床实践或患者结局相关的评估指标。本次分析共纳入15项研究：4项随机对照试验（Randomized Controlled Trial, RCT）、3项非随机对照试验，以及8项前后对照（纵向队列）研究。纳入研究间存在显著异质性，无法开展具有临床意义的对比分析；同时由于采用主观评估手段，各研究存在不同程度的偏倚，这限制了研究结果的有效性。研究结果显示，循证医学干预可在短期内提升医师的知识与技能，但尚无可靠证据表明其能改善长期知识储备、执业态度及临床实践。此外，尚无研究对患者结局与就医体验的改善情况进行评估。针对执业医师的循证医学培训，应纳入行为变革评估指标，并同步纳入患者结局与就医体验相关的评估维度。