Clinically Integrated E-Learning of Evidence-Based Medicine Improves Knowledge, Skills in Resource-Limited Countries

Embargoed for Release: 3 p.m. CT Tuesday, December 4, 2012

Media Advisory: To contact corresponding author Khalid S. Khan, M.B.B.S., M.Sc., email

Regina Kulier, M.D., of the World Health Organization, Geneva, Switzerland, and colleagues conducted a study to evaluate the effects of a clinically integrated e-learning evidence-based medicine (EBM) course on knowledge, skills, and educational environment in comparison with traditional EBM teaching in a group of low-middle-income countries.

“Evidence-based medicine encourages assimilation and implementation of new, valid, and relevant scientific knowledge by health care professionals as part of their daily clinical work. To be effective at achieving this, EBM curricula need to be clinically integrated,” according to background information in the article. “In low-middle-income countries (LMICs) there is a scarcity of EBM-trained clinical tutors, lack of protected time for teaching EBM, and poor access to relevant databases in languages other than English.”

The randomized trial was conducted between April 2009 and November 2010 among postgraduate trainees in obstetrics-gynecology in 7 LMICs (Argentina, Brazil, Democratic Republic of the Congo, India, Philippines, South Africa, Thailand). Each training unit was randomized to an experimental clinically integrated course consisting of e-modules using the World Health Organization Reproductive Health Library (RHL) for learning activities and trainee assessments (31 clusters, 123 participants) or to a control self-directed EBM course incorporating the RHL (29 clusters, 81 participants). A facilitator with EBM teaching experience was available at all teaching units. Courses were administered for 8 weeks, with assessments at baseline and 4 weeks after course completion. The study was completed in 24 experimental clusters (98 participants) and 22 control clusters (68 participants).

After the trial, the experimental group had higher average scores in knowledge and skills. Although there was no difference in improvement for the overall score for educational environment, there was an associated average improvement in the domains of general relationships and support and EBM application opportunities.

“The associated improvements in educational environment suggest that EBM principles that are learned may become culturally embedded in the workplace,” the authors write.

(JAMA. 2012;308[21]:2218-2225. Available pre-embargo to the media at

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