Is Pre-Clerkship EBM Instruction Reinforced in Clinical Clerkships? Results of an Observational Study

Introduction: The accrediting body for U.S. medical schools has proposed 13 sets of clinical competencies-Entrustable Professional Activities (EPAs)-that medical school graduates should possess upon entering residency (https://www.aamc.org/initiatives/coreepas). EPA7 defines competencies for Evidence-Based Medicine. These competencies are typically taught in the preclerkship curricula. However, little is known about how-or whether-EBM instruction is carried through to students' practice-focused learning in the clinical years. This qualitative study investigated the extent to which EBM teaching is incorporated into clinical clerkships. Methods: The investigator shadowed clerkship faculty, residents, and students on patient rounds and in didactic trainings at a large teaching hospital in Fall 2019 to capture instances of EBM teaching and practice. Demonstrations of EBM instruction, practice, and competency assessment were recorded on a field guide, which was comprised of functions, competencies, and behaviors as described in EPA7. Informal interviews were conducted with medical librarians and clinical faculty, concerning frequency and depth of student exposure to EBM competencies as applied to patient cases, assessment methods, use of UpToDate, and extent of librarian involvement. Aggregated observations of functions, competencies, and behaviors were categorized by EPA7 competency levels, and exemplars identified to highlight how observations corresponded to or conflicted with the interview data. Frequencies of all EPA teaching were compared. Results: Observations of clinical teaching were recorded in various activities in several clerkships. Data collection concluded in November 2019. Data analysis will be completed by February 2020 and results will be reported at the meeting. Discussion: Conclusions will be presented at the meeting.