Development of a best practice model for teaching and learning evidence-based health care at Stellenbosch University, South Africa

[摘要] ENGLISH ABSTRACT: This thesis used a mixed-methods approach to investigate how teaching and learning ofEvidence-based Health Care (EBHC) could best be integrated in medical student training toenhance student EBHC knowledge, attitude and skills.An overview of systematic reviews assessing the effects of teaching EBHC showed thatclinically integrated multifaceted strategies with assessment were more effective than singleinterventions or no interventions for enhancing knowledge, attitude and skills.Implementation of clinically integrated EBHC teaching and learning was further exploredthrough interviews with programme coordinators from around the world. Informants wererequested to provide data on the various approaches used, and on barriers and facilitatorsencountered with programmes aimed at teaching and learning EBHC in an integratedmanner. By far the most common challenges were lack of space in the clinical setting,EBHC misconceptions, resistance of staff and lack of confidence of tutors, time, andnegative role modelling. Critical success factors identified were pragmatism and nimblenessin responding to opportunities for engagement and including EBHC learning into thecurriculum, patience, and a critical mass of the right teachers who have EBHC knowledge,attitudes and skills and are confident in facilitating learning. In addition, role modelling withinthe clinical setting and the overall institutional context were found to be important forsuccess.The next phase involved conducting a set of studies to determine the opportunities for, andbarriers to, implementing EBHC teaching and learning at Stellenbosch University's (SU)Faculty of Medicine and Health Sciences. This included a curriculum document review,survey of recent graduates and interviews with faculty. EBHC teaching was found to befragmented and recent graduates called for more teaching of certain EBHC competencies.Module convenors identified a number of factors that needed to be addressed: contextualfactors within the faculty (e.g. recognition for teaching), health sector issues (e.g. clinicalworkload), access to research evidence, and issues related to educators (e.g. competingpriorities) and learners (e.g. motivation). Interviewees also emphasised the importance ofeducators as facilitators and role models.A cross-sectional study of SU was conducted to assess SU educators' knowledge of,attitude to and confidence in practicing and teaching EBHC as well as perceived barriers topracticing and teaching EBHC. Limitations to practicing EBHC identified included lack oftime, clinical workload, limited access to internet and resources, knowledge and skills.Respondents' called for reliable internet access, easy point-of-care access to databasesand resources, increasing awareness of EBHC, building capacity to practice and facilitatelearning of EBHC, and a supportive community of practice.Finally, drawing on the findings of the preceding quantitative and qualitative studies, andtaking into account the context of various EBHC initiatives in the African region, an outlineproposal is presented for a cluster randomised trial to evaluate alternative options forimplementing a clinically integrated EBHC curriculum in an African setting.

[发布机构] Stellenbosch University