Evidence-based medicine and life-long learning competency requirements in new residency teaching standards

The objective of this study is to compare accreditation standards across medical and surgical specialties in the USA to determine the requirements for evidence-based medicine (EBM) and information management (life-long learning) skills education in residency training programmes in the USA. We performed a descriptive analysis of ‘milestones’ statements that form the basis for oversight of residency training of the Next Accreditation System for the 28 major specialties and the transition year residency, searching the milestone statements for competency requirements for 15 EBM or information management topics. The search was performed independently by pairs of researchers, with a third researcher independently verifying their findings. No specialty requires all 15 topics. Basic EBM knowledge is required by fewer than half of all specialties. Only 14% of milestone statements specify the ability to identify bias in clinical research trials. Most specialties (79%) require demonstration of the use of evidence in practice. MEDLINE searching capability is required by 52% of specialties; competence in using secondary sources is required by 69%. There is little emphasis (22%) on evaluation of these information sources. Evaluation of information from experts, colleagues or pharmaceutical representatives is required by only 38%. Competence in developing methods of keeping up with new evidence is specified by only four specialties (14%). The results signal a shift in teaching requirements during residency training, away from classic evidence-based and towards information management skills. However, requirements are limited to published materials and rarely extend to information from human sources.