Enhancing knowledge and digital skills for implementing evidence-based practice

Case study author: Dr Claire Stapleton

School of Allied Health Professions, Faculty of Medicine and Health Sciences

CDF Framework: Authentic Assessment, Technology Enhanced Learning

Project Summary

This innovation implements an authentic assessment, in addition to building the student's digital literacy across many domains outlined in the Digital Literacy Capability Framework (2018). The aim is to enhance the students' knowledge and digital skills required to effectively implement evidence-based practice. Specifically, 'formulating a well built clinical question' and 'finding the best available evidence'. To facilitate acquisition of these knowledge and skills an intended learning outcome was added to a module to include: ‘formulate effective search strategies using health related databases’ and a 30 minute computer based task was introduced as an assignment. The assignment requires the student to formulate a clinical question (from an unseen case scenario), identify the PICO (Population, Intervention, Control, Outcome) components from the question and present a search strategy using Medline (database of life sciences and biomedical literature).

The assessment replicates the skills required to implement evidence-based practice in the real-world of clinical practice and requires the student to engage with and understand how to use technology to support their role as a physiotherapist. Teaching is delivered to support the requirements of the assessment (and includes video capture of a Medline database search incorporating both free text search terms, medical subject headings and combining searches using boolean operators (AND, OR)).

There are five steps to performing evidence-based practice. They are:

  1. Formulating a well built clinical question
  2. Finding the best available evidence
  3. Critically appraising the evidence
  4. Implementing the evidence 
  5. Evaluating the outcome.

Whilst our curriculum integrated critical appraisal and clinical placements encouraged opportunities for implementing the evidence and evaluating outcomes, there were gaps in students' knowledge and skills related to the first two steps of the process i.e. formulating a well built clinical question and finding the best available evidence.

Through teaching, practice and assessment the students learn how to formulate a well built clinical question based on a variety of clinical case scenarios, and how to access, navigate and compile effective search strategies to identify the available evidence related to a clinical question. The approach used covers principles of database searching to allow for knowledge and skills to be easily transferable to other health databases and into their working life as a health professional.

To date, approximately 257 undergraduate students over 3 years have undertaken the associated teaching, learning and assessment for this database searching task. On average 85% of students demonstrated proficiency in the skills required to implement these initial stages of EBP over the last three academic years, with a mean mark of 59% (ranging from 10% to 90%).

Students appeared to recognise the authentic attributes of the task and its value in their future role as a physiotherapist as evidenced by 84% of students agreeing with the statement 'the module enabled me to develop skills that will help my employability or career development' and comments specifically related to the database searching assignment included:

'I think it has made me more employable and confident in literature searching', 'different methods of assessment which will help us for the future', 'useful learning a structured method of literature searching' and 'I liked the computer based exam as this was more practical for future searching'.

In addition, the associated teaching and learning for these skills has formed a CPD training session for qualified Physiotherapy practice educators and the skills video (not the assessment) is used within our postgraduate teaching.

Evidence-based practice (EBP) is considered a life-long learning technique that may help healthcare practitioners continue to improve practice methods and approaches to patient care. It is defined as 'the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions' (Sackett et al., 2000). Therefore, the knowledge and skills required to perform all steps involved in implementing EBP (including the digital skills required to navigate databases to find the best available evidence) are applicable to all healthcare educational training programmes.