Introduction of evidence-based medicine into an ambulatory clinical clerkship

Evidence-based medicine (EBM) has emerged has a critical clinical competenc y in the 21st century. Medical schools usually introduce students to critic al appraisal in the preclinical years, but there have been few evaluated in terventions in teaching EBM in the clinical years. We describe a strategy t o encourage students to practice EBM during a required ambulatory medicine clerkship. During this clerkship, our students are required to submit an EB M report, which is prompted by an individual case, and structured with a 5- step approach. One small-group session is devoted to modeling this approach with a case of chest pain. Using a checklist to grade 216 consecutive EBM reports, we found that students were quite successful with the exercise, ac hieving on average 89.6% of possible checklist points. Students who followe d the structure of the exercise closely were more likely to extend their di scussions beyond that required and to suggest potential further areas of in vestigation or design.