Objective: To teach internal medicine residents key principles of clinical epidemiology that are necessary to read critically the medical literature.
Design: Two-phase, non-randomized, controlled educational trial.
Setting: University-based training program for residents (PGY-l-PGY-3) in internal medicine.
Participants: All 83 residents participated in the trial. Seventy residents completed a test in clinical epidemiology at the end of Phases I and II.
Interventions: Residents were assigned to one of eight ambulatory care clinics for half a day each week. A literature-based curriculum in critical appraisal was the subject of a weekly pre-clinic conference for four clinics (Group A). The other four clinics (Group B) had a weekly conference on topics in ambulatory care medicine. At the end of Phase I, both groups were given a test of basic knowledge of clinical epidemiology. The curriculum was then modified with the addition of written questions to emphasize important educational points and to stimulate resident participation. The modified curriculum became the subject of the pre-clinic conference for Group B, while Group A changed to topics in ambulatory medicine. At the end of Phase II both groups were again tested on basic knowledge of clinical epidemiology.
Results: Group B performed significantly better on the second test than on the first, 68.5% vs. 63.3% (p = 0.034), while Group A did not improve (64.5% vs. 65.9%). The differences in test scores for Test II minus Test I were +5.17% in Group B and -1.44% in Group A (p = 0.019). Twenty-one percent of Group B residents vs. 5% of Group A residents improved their scores by 18% or more.
Conclusions: The residency period is a difficult but important time to teach critical appraisal skills. Educational gains may be small and need to be critically evaluated to stimulate the development of more effective educational programs.