Table 3.
Key methods for teaching undergraduate healthcare students EBP, the Sicily Statement’s five steps of teaching and conducting EBP and context
| Source (first author, year) | Key methods for teaching undergraduate healthcare students EBP | The Sicily Statement’s five steps in teaching and conducting EBP | Context | ||||
|---|---|---|---|---|---|---|---|
| 1. Ask a clinical question | 2. Collect the most relevant evidence | 3. Critically appraise the evidence | 4. Integrate the evidence with one’s clinical expertise, patient preferences, and values to make practice decision | 5. Evaluate change or outcome | |||
| Balakas, 2010 [23] | Research courses and workshops | Students learned how to use their clinical PICO question… | ..as a guide for conducting literature searches | Students were guided in the use of rapid appraisal guidelines for quantitative and qualitative research. Written critical appraisals were completed to further develop students’ critiquing skills | Each student group presented their PICO questions, evidence synthesis, reference list, and recommendations to the community programme managers | Students learned to evaluate a body of evidence | Classroom + clinical practice |
| Bloom, 2013 [26] | Research courses and workshops | Nursing Science I: The process of reviewing the literature is explored, and the final project for the course is a literature search designed to identify the most current evidence available for a given topic | Nursing Science II: The emphasis of the course is on critical appraisal of a primary research report | Nursing Science III: Students use evidence-based models to systematically practice decision-making skills related to a clinical question of interest to them | Classroom | ||
| Boyd, 2015 [27] | Research courses and workshops | Classroom | |||||
| Cable-Williams, 2014 [29] | Research courses and workshops | Classroom + clinical practice | |||||
| Davidson, 2016 [33] | Research courses and workshops | Students learn to develop PICO clinical questions… | …searches for external evidence to answer focused clinical questions… | …participates in the critical appraisal of published research studies… | …to determine their strength and applicability to clinical practice… | …and disseminates best practices supported by evidence to improve quality of care and patient outcomes | Classroom |
| Dewar, 2012 [35] | Research courses and workshops | Four 3-h writing workshops including how to develop a clinical question… | …and identify relevant information from published researchstudies | Classroom | |||
| Friberg, 2013 [42] | Research courses and workshops | Students had a close collaboration with librarians with ten different workshops focusing on different aspects of literature retrieval | Students used knowledge-based analysis of both quantitative and qualitative results… | …and best evidence for a specific nursing action and transformed results and new knowledge into practice | Classroom | ||
| Jakubec, 2013 [47] | Research courses and workshops | Students wrote their appraisal of evidence in an existing policy or guideline… | …met with a health reference librarian to conduct a systematic search of the literature on the topic… | …provided a critical review of existing evidence with the policy or guideline and reviewed any updated or more recent evidence… | …and wrote a summary of their recommended policy changes for practice | Classroom | |
| Jalali-Nia, 2011 [48] | Research courses and workshops | The evidence-based approach, learning activities for each group included developing a clinical question using the PICO… | …searching for evidence… | …reading and critiquing nursing research… | … and discussing articles, synthesising the evidence, and developing a summary of findings | Classroom | |
| Janke, 2012 [49] | Research courses and workshops | Students had to clarify the research question… | …designing a literature search strategy and complete the search… | …select the articles and record important data from the articles… | …and submit the paper/results to the clinical partners | Classroom | |
| Jelsness-Jørgensen, 2015 [50] | Research courses and workshops | Week 1: Lectures in databases and literature search | Week 1: Introduction to Critical Appraisal Skill Tools. Week 2: Group work and seminars focusing on critical appraisal of qualitative papers. Week 3: Group work and seminars focusing on critical appraisal of quantitative papers | Classroom | |||
| Jones, 2011 [52] | Research courses and workshops | The assessment tasks were designed to enable students to conduct and report a critique of a published paper | The third and fourth assessment tasks were designed to enable students to apply the skills they had learnt in the subject | Classroom | |||
| Kiekkas, 2015 [54] | Research courses and workshops | Classroom | |||||
| Kyriakoulis, 2016 [10] | Research courses and workshops | Interventions covered different steps of the EBP domains: Research question… | …sources of evidence…2 studies focused on the searching databases skill | …evidence appraisal… | …and implementation into practice… | Classroom | |
| Leach, 2016 [55] | Research courses and workshops | Identification and development of research question from practice | Construction and execution of search strategies to retrieve relevant primary research articles | Critical appraisal of the literature | Summary, presentation and dissemination of evidence in different formats | Classroom + clinical practice | |
| Lewis, 2016 [56] | Research courses and workshops | The EBP1 course aimed to develop foundation knowledge and skills in EBP, with emphasis on three of the five EBP steps outlined in the Sicily Statement incl. Frame a research question… | …to access and search library databases and other resources and to reflect on the processes associated with this approach. | The EBP2 course had additional training inAppraising methodological bias… | …as well as teaching students how to apply each of the five EBP steps | Classroom | |
| Liou, 2013 [57] | Research courses and workshops | Mini research project with introduction how to formulate a research problem… | …conduct literature searches… | …read and select articles… | …and an oral and poster presentation of findings | Classroom | |
| Morris, 2016 [65] | Research courses and workshops | Classroom | |||||
| Phillips, 2014 [75] | Research courses and workshops | Classroom | |||||
| Pierce, 2016 [76] | Research courses and workshops | During the e-poster conference students develop a research question… | …appraise data collection… | …critique published literature… | …and write about how to begin a change to organisational visitation policy based on the research evidence from the poster conference | Classroom | |
| Rodriguez, 2012 [83] | Research courses and workshops | Students conducted a research project which included a literature review… | …presented their results and designed a scientific poster with their results | Classroom | |||
| Whalen, 2015 [97] | Research courses and workshops | The worksheet included mainly step 1–3 of EBP. Asking a clinical question using PICO… | …searching the literature… | …and critically appraising the literature found | Classroom | ||
| Zhang, 2012 [100] | Research courses and workshops | Students independently conducted online and library searches to find information | Students were asked to read an assigned article and critique it to the best of their ability | Students created presentation slides and shared an in-depth critique of one aspect of the specified research article | Classroom + clinical practice | ||
| Milner, 2017 [62] | Research courses and workshops | Students learn to build and frame practice questions by gaming | Classroom | ||||
| Sukkarieh-Haraty, 2017 [96] | Research courses and workshops | Students learned how to use a clinical PICO question | …and collected scholarly literature | Compared their observations to hospital protocol against the latest evidence-based practice guidelines | Students proposed changes in practice with scholarly literature | Classroom + clinical practice | |
| Erichsen, 2018 [40] | Research courses and workshops | Ask a clinical question | Collect relevant literature/articles | Critically appraise the articles | Students present their work in different ways; e.g. implementation-plan, poster | The results were evaluated | Classroom + clinical practice |
| Scurlock-Evans, 2017 [90] | Research courses and workshops | Students were taught what EBP is, how it links with research methodology and process and ethics (in year 2) | Students were taught how to assess quality of literature/evidence (in year 1) | Students undertook an independent research project in their final year (3 year) | Classroom | ||
| Keiffer, 2018 [53] | Research courses and workshops | Students ask a PICOT (population, intervention, control, outcomes, time) question | Develop strategies to search – and search | Appraise research | Design a change and disseminate the evidence by making recommendations for best practice | Classroom | |
| Sin, 2017 [91] | Research courses and workshops | Faculty have framed questions/students develop a question using PICO later in their nursing school | Acquiring evidence by selecting evidence-based resources through literature in collaboration with a librarian | Students state the rationale for their intervention choice incorporating the appraisal learned in the class | Students are asked to identify at least three EBP implementation strategies based on their literature review using at least two references | Classroom | |
| Coyne, 2018 [31] | Research courses and workshops | Students learned how to ask research questions and how to lean on one another for help and guidance | Students helped the faculty member in her research project to collect relevant literature | …including helping with initial review of the literature | Students did a formal podium presentation regarding their summer experiences. The programme led to changes at the health system and led to initiation of research studies | Classroom + clinical practice | |
| Hande, 2017 [44] | Research courses and workshops | Students identify the potential clinical questions as they become aware of current generalist nursing care problems | Students are guided through the sequence of steps to review research | Students critically appraise the scholarly information | Students are guided through the sequence of steps to develop an EBP implementation plan | Students make a presentation of an evidence-based project addressing a selected clinical problem for the purposes of improving clinical outcomes: Population/patient, problem, intervention, comparison, outcome, time question, recommendations for evidence-based practice change | Classroom + clinical practice |
| Malik G, 2017 [59] | Research courses and workshops | Asking clinical questions | Finding relevant evidence (sometimes workshops delivered by the library staff) | Appraising the evidence | Applying evidence into clinical practice (theoretically) | Classroom | |
| Berven, 2010 [24] | Collaboration with clinical practice | Clinical practice | |||||
| Elsborg Foss, 2014 [38] | Collaboration with clinical practice | Students were taught in computer-based literature search | Students read, appraised, and discussed the articles that were chosen | Students presented the findings from the literature search about ‘best practice’ and the recommendations for changes… | …and second-year students observed to what extent the decisions about changes were followed | Classroom | |
| Gray, 2010 [43] | Collaboration with clinical practice | In the introductory nursing research course prior to the research partnership, all nursing students are required to complete an evidence-based research project including the five steps | Classroom + clinical practice | ||||
| Moch, 2010 [64] | Collaboration with clinical practice | Classroom | |||||
| Moch, 2010 [63] | Collaboration with clinical practice | In discussion groups students found four articles related to the topic… | …and students and staff, along with faculty, read and discussed each of the articles in four discussion sessions | Classroom | |||
| Odell & Barta, 2011 [71] | Collaboration with clinical practice | Assignment outcomes related to step 2 and 3: Collaborate in the collection of evidence and participate in the process of appraisal, of evidence | Clinical practice | ||||
| O’Neal, 2016 [70] | Collaboration with clinical practice | Students wrote a related PICOT question… | …conducted a review of the literature | …followed guidelines to critically appraise articles | …identified application to practice | …developed recommendation for the future | Clinical practice |
| Pennington, 2010 [73] | Collaboration with clinical practice | Students wrote up the formalised research proposal | Students performed literature searches and… | …were instruments in collection and analysis of the pre-implementation survey data | The partnerships offered students + staff an opportunity to experience how make best practice decisions using a systematic EBP process | Classroom + clinical practice | |
| Raines, 2016 [78] | Collaboration with clinical practice | Students searched relevant evidence and… | …reviewed the literature found and appraised the quality of the evidence found | Classroom + clinical practice | |||
| Reicherter, 2013 [80] | Collaboration with clinical practice | Students learn to develop an evidence-based question… | …search for and retrieve relevant journal articles… | …analyse the results… | …student teams create and present a case report to classmates and outline potential clinical decisions using the evidence | Classroom + clinical practice | |
| Schams, 2012 [87] | Collaboration with clinical practice | Students were encouraged to write a clinical question using PICOT. | The group was divided into teams who shared the responsibilities for searching and reporting EBP information that supported or refuted current practice. As a team students discussed relationships among laboratory concepts, current practice, and EBP information found in literature. By using post-conference time immediately following clinical practice experiences, students could associate their personal experiences in practice with the EBP information. | Classroom + clinical practice | |||
| Scott, 2011 [89] | Collaboration with clinical practice | Students learned to write PICOT questions… | …and search the literature | Students learned appraisal and met with therapists to validate direction of search… | …and relevance of evidence to practice | Classroom + clinical practice | |
| Smith-Stoner, 2011 [92] | Collaboration with clinical practice | Students performed literature searches… | …and presented editing policy to clinical staff | Clinical practice | |||
| Smith-Strøm, 2012 [93] | Collaboration with clinical practice | The 12 –day course trained the students in the four steps of EBP: Formulating a question… | …searching for evidence… | …critically appraising the evidence… | …and applying the evidence | Clinical practice | |
| Brown, 2015 [28] | IT Technology | The iPad provided point-of-care access to clinical guidelines and resources… | …enabling students to implement an evidence-based approach to decision making and problem solving | Classroom | |||
| Callaghan, 2011 [30] | IT technology | Staff revealed two key research processes as being vital to students’ understanding of research and subsequent critical appraisal, these being searching for… | …and evaluating literature | Classroom | |||
| Doyle, 2016 [36] | IT technology | Mobile software is a positive information tool for information literacy… | …and for informing clinical decisions | Clinical practice | |||
| Eales-Reynolds, 2012 [37] | IT technology | Students indicated that the WRAP improved their critical appraisal skills… | …and questioning of the research evidence basis for practice | Classroom | |||
| Morris, 2010 [66] | IT technology | The guideline appraisal activity helped students formulated a searchable question | The guideline appraisal activity helped students retrieve evidence | The guideline appraisal activity helped students critically appraise the evidence | The guideline appraisal activity helped students apply the evidence to practice | Clinical practice | |
| Nadelson, 2014 [68] | IT technology | Critical group appraisals of EBP websites relevant for clinicians | Classroom | ||||
| Revaitis, 2013 [81] | IT technology | Through FaceTime videoconference students benefit from interacting with research teams and are able to discuss how research findings are applied to practice | Classroom | ||||
| Strickland, 2012 [95] | IT technology | Classroom | |||||
| Blazeck, 2011 [25] | Assignments | The main purpose of the assignment is accessing research-based evidence relevant to an identified clinical problem | Classroom | ||||
| Dawley, 2011 [34] | Assignments | Students were to generate relevant clinical questions that evolved from their clinical experiences… | …and were asked to conduct a literature search to identify two research articles that began to answer their questions | Classroom | |||
| McCurry, 2010 [61] | Assignments | Students completed a database search and met with the course faculty to refine electronic searches… | …critically examined the literature… | …and submitted abstracts and prepared an oral presentation and poster of the chosen articles | Classroom | ||
| Nadelson, 2014 [67] | Assignments | Students receive an article to be reviewed, read and critically appraise using the CASP tool | Classroom | ||||
| Roberts, 2011 [82] | Assignments | Students learned to search the literature using a variety of mechanisms | Classroom | ||||
| Andre, 2016 [22] | Participation in research projects | Increased understanding of the importance of critical thinking | Increased understanding of the importance of implementation of research in daily practice | Increased understanding of the importance of evaluation of clinical practice through the use of EBP | Classroom + clinical practice | ||
| Henoch, 2014 [45] | Participation in research projects | Students collected data | Classroom + clinical practice | ||||
| Niven, 2013 [69] | Participation in research projects | Students collected both qualitative and quantitative data using questionnaires | Classroom + clinical practice | ||||
| Ruskjer, 2010 [85] | Participation in research projects | Faculty guide the team in constructing the question in PICO | Librarian provides guidance in the computer laboratory, as students gain hands-on experience conducting an online literature search | The team critically appraises systematic reviews and practice guidelines, and individual students appraise relevant research articles | Faculty assists the team in looking at the evidence and discusses any recommended changes in practice | Classroom | |
| Schreiner, 2015 [88] | Participation in research projects | Students initiated the project by conducting a literature review for EBP articles related to heart failure education | Articles were chosen by their relevance to the enhancement of staff education for heart failure patients | Clinical practice | |||
| Laaksonen, 2013 [58] | Journal clubs | Students searched for scientific knowledge to answer a clinical question of the journal club… | …evaluated the articles and other relevant material… | …and prepared short written papers based on the knowledge they had collected and evaluated | Classroom | ||
| Mattila, 2013 [60] | Journal clubs | Students prepared for the journal club by acquiring data with the help of an information specialist | After presenting the article, participants discussed how the results could be used in nursing care and what type of solution or new perspective had been gained. Students generated the discussion and gave their opinion of the both oral and written | Classroom | |||
| Phelps, 2015 [74] | Embedded librarians | The ILCSN will help students gather… | …analyse… | …and use information | Classroom | ||
| Putnam, 2011 [77] | Embedded librarians | The embedded librarian assisted students in developing appropriate search techniques | The summative EBP paper developed the review of literature, including integrating, analysing… | …applying, and presenting information | Classroom | ||
| Aglen, 2016 [21] | Theories of teaching – and learning | The pedagogical strategies presented invite the learner to become an active participant in the learning activity, e.g. assessing research, conducting a research project and assessing patients’ requirements for healthcare. This means that they are encouraged to use discretion to solve ill-structured problems related to the steps of EBP, the research process and their own clinical practice. Another strategy to enhance students’ interest and make the learning tasks relevant is to link the learning task to real clinical situations | Classroom | ||||
| Crawford, 2011 [32] | Theories of teaching – and learning | PBL enhances critical thinking… | ..and transfer of theory to practice | Classroom + clinical practice | |||
| Epstein, 2011 [39] | Theories of teaching – and learning | Classroom | |||||
| Florin, 2012 [41] | Theories of teaching – and learning | Highest correlation coefficients between students’ experience of support for research utilisation and EBP skills in formulating questions to search for research-based knowledge (step 1) and critically appraising and compiling best knowledge (step 3) on campus. | Classroom + clinical practice | ||||
| Hickman, 2014 [46] | Theories of teaching – and learning | Classroom | |||||
| Johnson, 2010 [51] | Theories of teaching – and learning | Students develop their own research proposal, which includes defining a research question… | …searching the literature… | …and formulate appropriate methods | Classroom | ||
| Oja, 2011 [72] | Theories of teaching – and learning | All studies except one in the review found significant effects of PBL on critical thinking skills | Clinical practice | ||||
| Raurell-Torredà, 2015 [79] | Theories of teaching – and learning | Classroom + clinical practice | |||||
| Rolloff, 2010 [84] | Theories of teaching – and learning | Students will develop information literacy skills… | …explore systematic review databases for evidence related to laboratory experiences and introduce other information literacy sources | …critique websites, research articles and clinical experiences from an EBP perspective for health information | …incorporate EBP into patient care plans and develop a research proposal based on evidence gaps identified in practice | …and evaluate clinical policies and procedures from an EBP perspective and discuss change process | Classroom |
| Ruzafa-Martinez, 2016 [86] | Theories of teaching – and learning | Students should identify a nursing problem in patients cared for during clinical training and formulate a clinical PICO question... | …identify clinical practice guidelines, systematic reviews and/or original articles… | …critically appraise search results… | …describe recommendations on the clinical question and identify the level of evidence and grade of recommendation… | …and present the results of the final exercise in a poster to the seminar group, giving reasons for implementation of the search results | Classroom |
| Stombaugh, 2013 [94] | Theories of teaching – and learning |
Sophomore-level: Students generated a PICO question…Students copied the process of the librarian describing an example of a PICO question, creation of a search term and conduction of a search in CINAHL Junior level: Students searched databases other than CINAHL Senior level: Students created PICO related to practice experience, individually searched databases and retrieved “best practice” evidence |
Classroom | ||||
| Wonder, 2015 [98] | Theories of teaching – and learning | Students critically appraised analysis methods and findings in the context of quality and safety improvement… | …and identified implications for nursing and the inter-professional team | Classroom | |||
| Yu, 2013 [99] | Theories of teaching – and learning | Classroom | |||||