Implementing awareness program on evidence based medicine for pharmacy students.

Sir,

Evidence based medicine (EBM) is the conscientious, explicit and judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence based practice (EBP) is a process of care that takes the patient and his or her preferences and actions, the clinical setting including the resources available, and current and applicable scientific evidence, and knits the three together using the clinical expertize and training of the health-care providers.[12] EBM is an element in undergraduate, postgraduate, and continuing medical education. The knowledge on EBM and EBP is necessary for every pharmacist to assess the methods of diagnosis and treatment on the basis of the best available current scientific research data.[3]

The objective of the program is to create the awareness and to provide sufficient knowledge on EBM and EBP among the pharmacy students. A prospective observational education program was conducted at St. Peter's Institute of Pharmaceutical Sciences in Warangal. The awareness program was open to all the batches of B Pharmacy III and IV years, Pharm D I, II, III, and IV years, and M Pharmacy (Pharmacy practice) students. The lectures were delivered to the student participants in the EBM education program in their respective classrooms and it contained a variety of educational materials ranging from textbooks to current articles from various journals. To evaluate the program, participants were assessed before and after the education intervention by means of pre-intervention and post-intervention confidence assessments. In pre-intervention knowledge assessment a subjective peer reviewed structured questionnaire, containing 10 questions were prepared using various standard references and it was administered to each student to answer in a time period of 10 min before the education program commenced. The student's knowledge was assessed based on the score obtained of maximum 10. A brief lecture was presented on EBM and EBP. The topic covered under the lecture includes the definition of EBM, classification, sources and study for EBM, categories and levels in EBM, steps of EBP, limitations and applications of EBM for a period of 15-20 min in every individual classroom. After the completion of the lecture, a post-intervention confidence assessment containing the same questions as in the pre-intervention assessment was administered to the participants and asked to answer in a same time period of 10 min. Each participant served as his or her own control. The average scores of the individual classes pretest and posttest results were calculated. The Wilcoxon rank sum test was used to compare results. Any value of P value less than 0.05 is statistically significant.

A brief lecture was presented to 207 of the 250 students, for a participation rate of 82.8%. Out of 207 students, B. Pharmacy students were 100 (48.3%), Pharm. D students were 95 (45.9%) and M. Pharmacy (Pharmacy Practice) students were 12 (5.8%). The students participated from the individual classes were B. Pharmacy IV year 57 (27.5%), B Pharmacy III year 43 (20.7%), Pharm D IV year 22 (10.6%), Pharm D III year 22 (10.6%), Pharm D II year 23 (11.1%), Pharm D I year 28 (13.5%), and M Pharmacy 12 (5.8%). The majority of the students participated have some knowledge on the pharmacotherapy. The average score for the majority of confidence assessment questions increased by the end of the program. Responses to questions demonstrated significant improvement (P = 0.009).

Average competence test scores increased after the education program was implemented, and there was a significant difference between pretest and posttest average scores for individual classes. There was maximum improvement observed for the class Pharm D III year and was minimum for the class M Pharmacy students. The improvements from pretest to posttest average scores of the individual classes. Average pre and posttest scores for EBM competency among pharmacy students were summarized in the Table 1.

Table 1

Average pre-test and post-test scores for EBM

The importance of an EBM approach is that it engages clinical pharmacist in articulating clinical questions, searching for information, appraising the evidence, and applying the evidence in the actual clinical scenarios. Consequently, an important and necessary first step involves the assessment of both knowledge and attitudes to EBM.[45] Many of the students at the institution had previously informed us that they were not aware of the EBM and what actually it is. Confidence scores for a small subset of students belongs to certain classes was not increased up to mark after the program was implemented compared to other classes. To determine the reasons for this phenomenon, we asked participants for feedback on the program and found that the students of pharmacy practice and Pharm D IV year have not shown interest and attention to the lecture on the belief that they are satisfied with the knowledge they have earlier, where as the fresher's of Pharm D and other students of B. Pharmacy, who have no knowledge showed the much interest on lecture and their confidence after lecture increased significantly.

Our study results showed that the degree to which EBM is taught differs across various courses of pharmacy. The large difference across the students of various years of the individual pharmacy course is remarkable. The EBM scale had a high internal consistency. This may indicate that the different aspects of EBM are similarly well or poorly covered in pharmacy training. Teaching EBM seems to significantly important in pharmacy profession. Nevertheless, results suggest that in pharmacy field EBM is not a central aspect in pharmacy training and there is a need for the implementation of an education program on EBM to the upcoming pharmacist in every pharmacy institution.