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RESEARCH ARTICLE Open Access
Methods for teaching evidence-basedpractice: a scoping reviewCamilla Marie Larsen1,2,4* , Anne Seneca Terkelsen1, Anne-Marie Fiala Carlsen3 and Hanne Kaae Kristensen1,5
Abstract
Background: This scoping review aims to gather and map inspiration, ideas and recommendations for teachingevidence-based practice across Professional Bachelor Degree healthcare programmes by mapping literature describingevidence-based practice teaching methods for undergraduate healthcare students including the steps suggested by theSicily Statement.
Methods: A computer-assisted literature search using PubMed, Cinahl, PsycINFO, and OpenGrey covering health,education and grey literature was performed. Literature published before 2010 was excluded. Students should beattending either a Professional Bachelor’s degree or a Bachelor’s degree programme. Full-text articles were screened bypairs of reviewers and data extracted regarding: study characteristics and key methods of teaching evidence-basedpractice. Study characteristics were described narratively. Thematic analysis identified key methods for teaching evidence-based practice, while full-text revisions identified the use of the Sicily Statement’s five steps and context.
Results: The database search identified 2220 records. One hundred ninety-two records were eligible for full-textassessment and 81 studies were included. Studies were conducted from 2010 to 2018. Approximately half of the studieswere undertaken in the USA. Study designs were primarily qualitative and participants mainly nursing students. Seven keymethods for teaching evidence-based practice were identified. Research courses and workshops, Collaboration withclinical practice and IT technology were the key methods most frequently identified. Journal clubs and Embeddedlibrarians were referred to the least. The majority of the methods included 2–4 of the Sicily Statement’s five steps, whilefew methods referred to all five steps.
Conclusions: This scoping review has provided an extensive overview of literature describing methods for teaching EBPregarding undergraduate healthcare students. The two key methods Research courses and workshops and Collaborationwith clinical practice are advantageous methods for teaching undergraduate healthcare students evidence-basedpractice; incorporating many of the Sicily Statement’s five steps. Unlike the Research courses and workshop methods, thelast step of evaluation is carried out partly or entirely in a clinical context. Journal clubs and Embedded librarians shouldbe further investigated as methods to reinforce existing methods of teaching. Future research should focus on methodsfor teaching EBP that incorporate as many of the five steps of teaching and conducting EBP as possible.
Keywords: Teaching methods, Undergraduate healthcare students, Evidence-based practice, The Sicily statement
BackgroundDizon et al. state that healthcare can be inefficient, inef-fective and/or dangerous when it is not based on currentbest evidence [1, 2]. Therefore, to ensure the quality ofhealthcare, it is important to implement evidence-based
practice (EBP) in all health professional curricula, so thatfuture health professionals learn the fundamentals of re-search and the application of evidence in practice [2].Several definitions of EBP have been suggested in recent
years. The scientific evidence was initially developedwithin medicine, but as many health professionals haveembraced an evidence-based way of practice the SicilyStatement [3] suggested that the original term “evidence-based medicine” should be expanded to “evidence-based
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
* Correspondence: [email protected]; [email protected] Sciences Research Centre, UCL University College, Niels Bohrs Allé 1,5230 Odense M, Denmark2Department of Physiotherapy, UCL University College, Niels Bohrs Allé 1,5230 Odense M, DenmarkFull list of author information is available at the end of the article
Larsen et al. BMC Medical Education (2019) 19:259 https://doi.org/10.1186/s12909-019-1681-0
practice” in order to reflect a common approach to EBPacross all health professions.The Sicily Statement gives a clear definition of EBP to-
gether with a description of the minimum level of edu-cational requirements and skills required to practice inan evidence-based manner. This makes the underlyingprocesses of EBP more transparent and distinguishes be-tween the process and outcome of EBP [3].In order to fulfil the minimum requirements of
teaching and conducting EBP, the Sicily Statementputs forward a five-step model: (I) asking a clinicalquestion; (II) collecting the most relevant evidence;(III) critically appraising the evidence; (IV) integrat-ing the evidence with one’s clinical expertise, patientpreferences and values to make a practice decision;and (V) evaluating the change or outcome [4].Internationally, EBP skills are essential requirements in
clinical practice among both medical doctors as well asamong other health professionals. Healthcare studentsare mainly taught the first three steps of the Sicily State-ment’s five-step model. The last two steps are rarelytaught, and students and graduates thus lack competen-cies in applying their knowledge in the clinical settingduring or after graduation [5, 6].In terms of healthcare policy and ambitions in Denmark,
it was decided in 2015 that Professional Bachelor Degreehealthcare students were to contribute to the developmentof an evidence-based way of working, a faster implementa-tion of new knowledge in practice, and to the developmentof greater patient involvement and patient safety in the Da-nish healthcare system [7]. The Professional Bachelor’s de-gree is awarded after 180–270 ECTS and includes a periodof work placement of at least 30 ECTS. The programmesare applied programmes. They are development-based andcombine theoretical studies with a practical approach. Ex-amples of professional bachelor degree holders are nurses.The Danish title is Professionsbachelor and the English titleis Bachelor [8]. In Denmark the University College institu-tions solely provide professional bachelor degree educa-tions. Master degrees are awarded at the Universities.Based on the Sicily Statement students should be able to
reflect, ask questions, gather knowledge, critically ap-praise, apply and evaluate various kinds of knowledge atthe end of their course. The aim is that all ProfessionalBachelor Degree healthcare students across disciplines ofnursing, physiotherapy, occupational therapy, radiography,and biomedical laboratory science develop common EBPqualifications in order to contribute towards the develop-ment of evidence-based healthcare [9]. In order to ensureshared prerequisites and mutual understanding of the EBPconcepts before entering theoretical or clinical inter-professional education, further knowledge about how toteach EBP across disciplines is required [9]. By teachingthe fundamental principles of EBP, students will develop
their EBP skills and ability to put them into practice intheir studies and as future graduates.Previously, some systematic reviews were conducted
summarising various educational interventions orstrategies for teaching EBP to undergraduate health-care students [2, 10–12].In a review from 2014, Young and colleagues stated
that multifaceted interventions integrated into clinicalpractice contributed to the greatest improvements inEBP knowledge, skills, and attitudes [2]. In line with this,Kyriakoulis et al. suggested that a combination of inter-ventions, such as lectures, tutorials, workshops, confer-ences, journal clubs, and online sessions was best suitedfor teaching EBP to undergraduate healthcare students[10]. However, the majority of the articles in both re-views synthesized information from interventions orstrategies aimed at medical students at various educa-tional levels. Only a few articles elicited informationabout educational interventions and strategies aimed atundergraduate healthcare students in the disciplines ofnursing, physiotherapy, occupational therapy, radiog-raphy, and/or biomedical laboratory science. However,two recent reviews have specifically addressed EBPteaching for undergraduate nursing students [11, 12]. Asystematic review investigated the effectiveness of spe-cific educational methods and found an effect on studentknowledge, attitudes, and skills but could not draw aconclusion as to the advisability of one of the methods[11]. A literature review sought to identify knowledgeexperiences on teaching strategies from qualitative stud-ies in nursing EBP education to enhance knowledge andskills and points to a limited focus on the use of EBPteaching strategies. Additionally, the study points to theneed for more qualitative research investigating inter-active and clinically integrated teaching strategies. Des-pite both reviews being well-informing, a broad scopewhen mapping updated EBP teaching methods and strat-egies across healthcare bachelor educations will furtherqualify future interdisciplinary practices [11, 12].In order to implement the most effective ways of
teaching EBP across healthcare undergraduate students,an investigation of existing literature on the subjectneeds to be undertaken. For identifying, mapping anddiscussing key characteristics in the literature a scopingreview is the better choice [13].
Aim, objectives and review questionThe aim of this scoping review is to gather and map in-spiration, ideas, and recommendations for teachersimplementing EBP across Professional Bachelor Degreehealthcare programmes by mapping existing literaturedescribing EBP teaching methods, including the fivesteps of EBP suggested by the Sicily Statement, [3] re-garding undergraduate healthcare students.
Larsen et al. BMC Medical Education (2019) 19:259 Page 2 of 33
The primary question of the scoping review is: “WhichEBP teaching methods, including The Sicily Statement’ssteps of teaching and conducting EBP, have been re-ported in the literature with respect to undergraduatehealthcare students in classrooms and clinical practice?”
DefinitionsClassroom is defined as a room where classes are taughtin a school, college or university [14].Clinical practice refers to the agreed-upon and cus-
tomary means of delivering healthcare by doctors, nursesand other health professionals [15].
MethodsTo ensure a systematic methodology, The Joanna BriggsInstitute Reviewers’ Manual - Methodology for JBI Scop-ing Reviews has been used throughout the scoping re-view process [16, 17].
Inclusion criteriaParticipantsLiterature which included undergraduate healthcare stu-dents in the disciplines of nursing, physiotherapy, occu-pational therapy, radiography, and biomedical laboratoryscience was selected to ensure applicability and rele-vance to similar scientific disciplines at other institutionsof higher education. The undergraduate students shouldbe attending either a Professional Bachelor’s degree or aBachelor’s degree programme.
ConceptMethods for teaching EBP including The Sicily State-ment’s steps of teaching and conducting EBP was themain concept to be investigated in the review. That is;literature describing either recommendations of EBPteaching methods, evaluations of EBP teaching methods,teacher and/or student perceptions of EBP teaching andlearning methods, or qualifications obtained when learn-ing the principles of EBP.
ContextLiterature describing methods for teaching EBP con-ducted in a classroom setting, in clinical practice as partof the education, or in a combination of classroom andclinical practice was included in the review.
Exclusion criteriaIn the period up to 2010, the Bachelor Degree healthcare ed-ucations began to conform to European requirements regard-ing evidence-informed and evidence-based education [18].A maximum time frame (2010–2018) was applied, deter-
mined by the amount of available literature/research studiesand requirements of updated teaching strategies [19, 20].Therefore, literature published before 2010 was excluded.
Literature including undergraduate students in otherhealth disciplines such as medicine or dentistry was notreviewed as the structure of their education is based onanother paradigm. Nor was literature including partici-pants such as graduates, RN-to-BSN students, andtrained health personnel accepted for inclusion as theywere considered as postgraduates, not comparable toundergraduate students. With the primary aim of gather-ing ideas and inspiration for teaching EBP, literature thatfocused on issues other than methods for teaching EBPwas excluded, as well as literature in languages otherthan English, Danish, Norwegian, or Swedish.
Search strategyTo identify literature relevant to our research question,the databases MEDLINE via PubMed, CINAHL Complete,and PsycINFO (both via EBSCO) were systematicallysearched. These databases cover both health and educa-tion and are available to the primary local target audienceof this scoping review. Because of time limitations onlythe multidisciplinary European database, OpenGrey, wassearched in the attempt to find unpublished literature.The searches were conducted May 9th, 2018.As recommended in The Joanna Briggs Institute Re-
viewers’ Manual [16, 17], the search was conducted inthree steps in collaboration with a research librarian.
Step 1: The databases PubMed, covering the field ofbiomedicine and CINAHL, covering nursing and alliedhealth literature were searched using the keywords:‘teaching methods’, ‘teaching’, ‘learning methods’, ‘learning’,‘teaching strategies’, ‘learning strategies’, ‘undergraduate’,‘undergraduate education’, ‘student’, ‘biomedical laboratoryscientist’, ‘medical laboratory scientist’, ‘medical laboratorytechnologist’, ‘medical laboratory technologists’,‘radiographer’, ‘occupational therapist’, ‘physiotherapist’,‘nurse’, and ‘evidence-based practice’.Step 2: Through an analysis of text words in titles andabstracts of the studies found in PubMed and Cinahl,new keywords, which would improve the search, wereidentified. These were ‘allied health’, health students’,and ‘nursing’. All identified keywords were thenincluded in the search as a systematic block search inPubMed, Cinahl, and PsycINFO, covering literature inthe behavioural and social sciences, and OpenGrey,covering grey literature in Europe. Table 1 provides alist of the specific search queries used in all databases.Step 3: The reference lists of identified studies weresearched for additional studies.
Study selectionAll search results from the databases were imported to theweb-based bibliographic management software, RefWorks2017 by ProQuest. After exclusion of duplicates and
Larsen et al. BMC Medical Education (2019) 19:259 Page 3 of 33
records before 01.01.2010, two reviewers independentlyscreened titles and abstracts of the remaining articles forrelevance in relation to the research question and the in-clusion and exclusion criteria. Afterwards, all full-text arti-cles were further checked for relevance by twoindependent reviewers. Any inconsistencies between thetwo reviewers regarding study selection for final inclusionwere resolved by discussion with a third reviewer.
Data collectionData from the included articles were extracted using twodata extraction tools as recommended in The JoannaBriggs Institute Reviewers’ Manual [16, 17]. The firstdata extraction tool comprised study characteristics,while the other data extraction tool comprised methodsfor teaching EBP.Prior to the process of extracting data from the in-
cluded articles, a pilot test using the data extractiontools was conducted by one reviewer assessing nine arti-cles. To ensure agreement between reviewers, a secondreviewer checked the same articles. Any disagreementsabout the content or use of the data extraction toolswere discussed and resolved.One reviewer then extracted relevant data from all in-
cluded articles to the data extraction tools. Two otherreviewers split the same articles among them and ex-tracted data using the same data extraction tools. As afinal step, the first reviewer went through all extracteddata from all of the included articles with each of theother reviewers to ensure comparability and complete-ness in the final data extraction tools.
Synthesis and analysis of resultsThe data extraction tools formed the basis of the finalpresentation of the results in two tables consisting of“Study characteristics” and “Key methods for teachingEBP, the Sicily Statement’s five steps of teaching andconducting EBP and context”. Study characteristics in-cluded author, year of publication, title, journal, countryof origin, study design, study participants, methods forteaching EBP, and main study findings. The key methods
for teaching EBP were identified through a thematic ana-lysis. All full text articles were read and every teachingmethod found was listed. Through a revision of allteaching methods listed, seven themes were found thatdescribed the most prominent teaching methods, whichwere named “Key methods for teaching EBP”. Allmethods were then divided into one of the key methodsfor teaching EBP. In some articles, more than one teach-ing method was described. In that case, the teachingmethod most frequently described was selected andcategorised under the relevant key method. Throughfull-text revision the Sicily Statement’s steps of teachingand conducting EBP and the context (classroom, clinicalpractice or a combination of both) in which the teachingtook place was found. To further clarify the content ofthe two tables all results listed were described narra-tively. All tabulated data, except for the key methods forteaching EBP identified in Table 3, have been cited dir-ectly from the articles.
ResultsLiterature searchThe database search returned 2220 records: PubMed(n = 1469), Cinahl (n = 527), PsycINFO (n = 173), andOpenGrey (n = 51) (Fig. 1). Records published before01.01.2010 and duplicates were removed, which left1280 records to be screened by title and abstract. Basedon relevance, 1088 records were excluded and 192 re-cords were found eligible for full-text assessment. In ac-cordance with the inclusion and exclusion criteria, 111articles were excluded. The excluded articles concernedstudy participants other than undergraduate healthcarestudents (graduates, RN-to-BSN students, trainedhealth personnel), study participants from other health-care disciplines (medicine, dentistry, midwifery), issuesother than methods for teaching EBP (simulation teach-ing, community health nursing, EBP beliefs, etc.), andfull-text articles not available in English, Danish, Nor-wegian, and Swedish (French, Chinese). In agreementwith the other reviewers, 81 studies were finally in-cluded in the scoping review.
Table 1 Specific search queries, all databases
Database Search queries
PubMed (((((teaching OR learning))) AND (undergraduate OR student OR allied health OR health students)) AND ((biomedical laboratoryscientist OR medical laboratory scientist OR medical laboratory technologist OR medical laboratory technologists OR radiographerOR occupational therapist OR physiotherapist OR nurse OR nursing))) AND evidence-based practice
Cinahl Complete (teaching OR learning) AND (undergraduate OR student OR allied health) AND (biomedical laboratory scientist OR medicallaboratory scientist OR medical laboratory technologist OR medical laboratory technologists OR radiographer OR occupationaltherapist OR physiotherapist OR nurse OR nursing) AND evidence-based practice
PsycInfo viaEBSCO
(teaching OR learning) AND (undergraduate OR student OR allied health) AND (biomedical laboratory scientist OR medicallaboratory scientist OR medical laboratory technologist OR medical laboratory technologists OR radiographer OR occupationaltherapist OR physiotherapist OR nurse OR nursing) AND evidence-based practice
Open Grey (“Evidence based practice” OR EBP OR Evidence-based practice OR Evidence based practice) AND (teaching OR education OR learn-ing) AND (undergraduate OR student OR students)
Larsen et al. BMC Medical Education (2019) 19:259 Page 4 of 33
Study characteristicsStudy characteristics are presented in Table 2. Allstudies were spread across the years 2010–2018. Al-most half of the studies (n = 40) were conducted inthe USA, followed by Canada (n = 8), Norway (n =7), Australia (n = 6), England (n = 6), Sweden (n =3), China (n = 2), Finland (n = 2), Spain (n = 2),Greece (n = 1), Iran (n = 1), Lebanon (n = 1),Scotland (n = 1), and Taiwan (n = 1). The study de-signs were primarily qualitative (n = 55), while 23 ofthe studies were quantitative, and three of the stud-ies used a mixed method. The majority of the partic-ipants were nursing students (n = 72), followed by acombination of nursing students and students fromother healthcare disciplines (n = 5), nursing andphysiotherapy students (n = 1), physiotherapy stu-dents and students from other healthcare disciplines(n = 1), occupational and physiotherapy students(n = 1), and physiotherapy students only (n = 1).
Key methods for teaching EBP, the Sicily Statement’s fivesteps of teaching and conducting EBP and contextTable 3 presents the key methods for teaching EBP, theSicily Statement’s five steps of teaching and conductingEBP, and the context. Seven key methods for teachingEBP were identified: Thirty-two studies described “Re-search courses and workshops”. “Collaboration withclinical practice” was identified 14 times followed by “ITtechnology” (n = 8), “Assignments” (n = 5), “Participationin research projects” (n = 5), “Journal clubs” (n = 2), and“Embedded librarians” (n = 2). In addition, 13 studies de-scribed various theories of teaching and learning. Theseare not elaborated on as the theme is not consideredwithin the objective of this scoping review.In Table 3 the vast majority of the studies (n = 69) re-
ferred to one or more of the Sicily Statement’s five stepsof teaching and conducting EBP. Eleven studies referredto all five steps. Thirty-one studies referred to three orfour steps, while 17 studies referred to two of the steps,
Fig. 1 Modified PRISMA flow diagram illustrating the scoping review selection process
Larsen et al. BMC Medical Education (2019) 19:259 Page 5 of 33
Table
2Stud
ycharacteristics(N
=81)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
Aglen
[21]
2016
Pedago
gicalstrateg
ies
toteachbachelor
stud
entsEBP:A
system
aticreview
Nurse
EducationToday
Norway
Qualitative
Nursing
stud
ents
Theo
riesof
discretio
n,know
ledg
etransfer
and
cogn
itive
maturity
developm
ent
Nursing
stud
entsstrugg
leto
seethe
relevanceof
eviden
cefornu
rsingpractice.
Before
beingintrod
uced
toinform
ation
literacyandresearch
topics,stude
ntsne
edinsigh
tinto
know
ledg
etransfer
andtheir
ownep
istemicassumptions.Kno
wledg
etransfer
relatedto
clinicalprob
lemsshou
ldbe
thelearning
situations
prioritised
whe
nteaching
EBPat
bachelor
level.
And
ré[22]
2016
Embe
ddingeviden
ce-
basedpracticeam
ong
nursingun
dergradu
ates:
Results
from
apilot
stud
y
Nurse
Educationin
Practice
Norway
Qualitative
Nursing
stud
ents
Inform
ationabou
tvoluntary
participationin
twodifferent
clinicalresearch
projects,
educationprog
ramme
relatedto
EBP,participation
inclinicalresearch
projects,
instructions
anded
ucationin
analysinganddiscussing
finding
s
Improvem
entin
skillsandknow
ledg
edu
ring
thestud
y.Stud
entsstated
that
EBPmight
have
aninfluen
ceon
increasing
thequ
ality
ofnu
rsingpractice.
Balakas[23]
2010
Teaching
research
and
eviden
ce-based
practice
usingaservicelearning
approach
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
Aresearch
course
from
atradition
alform
atto
oneof
eviden
ceappraisaland
synthe
sis,which
incorporated
servicelearning
andcollabo
rativelearning
Research
coursestaug
htfro
man
EBP
perspe
ctivecanprovidemotivationfor
stud
entsto
incorporateresearch
into
their
practice.
Berven
[24]
2010
Stud
entscollabo
rate
with
nurses
from
anu
rsingho
meto
getan
eviden
cebased
practice...Fourth
Europe
anNursing
Con
gress
Journalo
fClinicalNursing
Norway
Qualitative
Nursing
stud
ents
Group
sof
stud
ents
coop
erated
with
profession
alsat
Løvåsen
teaching
nursingho
mein
iden
tifying
clinicalissues
that
couldbe
feasibleto
investigateandde
velopup
todate,state-of-artgu
ide-
lines
inrelatio
nto
mod
elfor
EBP
Stud
entshave
develope
dan
unde
rstand
ing
that
theprocessof
EBPshou
ldbe
utilisedin
clinicalpractice.
Blazeck[25]
2011
BuildingEBPinto
the
foun
datio
nsof
practice
Nurse
Educator
USA
Qualitative
Nursing
stud
ents
Assignm
entinclud
ing
choo
sing
relevant
topicand
searchingrelevant
databases
Thedidacticinstructionof
theconcep
tsof
search
andtheterm
inolog
yof
search,
collabo
ratin
gwith
amed
icallibrarianin
the
teaching
andthede
sign
oftheassign
men
t,thegradingrubricforthestud
ents,and
the
quality
controlvisualcorrectiontool
forou
rmultip
leraters,has
ledto
success
Bloo
m[26]
2013
Levelling
EBPconten
tforun
dergradu
ate
nursingstud
ents
Journalo
fprofessional
nursing
USA
Qualitative
Nursing
stud
ents
3un
dergradu
ateresearch
coursesde
sign
edto
prep
are
thegraduate
toiden
tify,
locate,readandcritically
appraise
eviden
ceat
the
individu
alstud
y,system
atic
review
,and
clinicalpractice
Thefoun
datio
nachieved
bybaccalaureate
graduatesstandthem
ingo
odsteadas
they
pursue
theirclinicalandacadem
iccareers.
Larsen et al. BMC Medical Education (2019) 19:259 Page 6 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
guidelinelevels
Boyd
[27]
2015
Using
Deb
ates
toTeach
EBPin
LargeOnline
Cou
rses
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
Interactivede
batesto
teach
EBPskillsin
anon
line
graduate
course
Stud
entsremainhigh
lyen
gage
dwhile
practicingcriticalthinking,
team
work,
leadership,d
eleg
ation,commun
icationskills,
andpe
erevaluatio
nthroug
hparticipationin
aseriesof
faculty-facilitated
onlinede
bates.
Brow
n[28]
2015
TheiPad:tablet
techno
logy
tosupp
ort
nursingandmidwifery
stud
entlearning
:an
evaluatio
nin
practice
Com
puters,Informatics,
Nursing
USA
Quantitative
Nursing
stud
ents
Use
ofiPads
iPadsrepo
rted
lyim
proved
stud
entefficiency
andtim
emanagem
ent,whileim
proving
theirability
toprovidepatient
education.
Stud
entswho
used
iPadsforthepu
rposeof
form
ativeself-assessmen
tappreciatedthe
immed
iate
feed
back
andop
portun
ityto
de-
velopclinicalskills.
Cable-
Williams
[29]
2014
Aned
ucational
inno
vatio
nto
foster
eviden
ce-in
form
edpractice
Journalo
fNursing
education
andPractice
Canada
Qualitative
Nursing
stud
ents
Threadingtheconcep
tof
eviden
ce-in
form
edpractice
andrelevant
bestpractice
guidelines
throug
htheo
rycoursesinclud
ingtheiruseas
expe
cted
elem
entsin
clinical
placem
ents
Theresults
ofresearch
areinform
ingclient
care
andacriticalapp
roachto
profession
alpracticeam
ongnu
rsingstud
ents.
Callagh
an[30]
2011
Enhancinghe
alth
stud
ents’und
erstanding
ofge
neric
research
concep
tsusingaweb
-basedvide
oresource
Nurse
Educationin
Practice
England
Qualitative
Physiotherapy
stud
ents
Inno
vativevide
oresources
Overall,stud
entspe
rceivedtheresourcesas
demystifying
thetopicof
research
metho
dsthroug
htheclarificatio
nof
definition
and
applicationof
concep
tsandmakingsenseof
concep
tsthroug
htheanalog
icalvide
os.
Coyne
[31]
2018
ACom
preh
ensive
App
roachto
Und
ergraduate
Nursing
Stud
ents’Research
Expe
riences
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
Summer
Research
Internship
(8weeks
durin
gthe
summer);supp
ortin
gstud
entsin
aon
e-to-one
men
torshipmod
elwith
the
goalof
buildingaresearch
infrastructurefacilitated
byresearchersandstud
ents
Theprog
rammeleadsto
practice
improvem
ents,kno
wledg
edissem
ination,
andstud
entinterestin
research
andfurthe
rprofession
alde
velopm
ent.Itgivesstud
ents
hand
s-on
expe
riencewith
nursingresearch
that
hasproven
tobe
bene
ficialclinically
whileincreasing
stud
entinterestin
research
andfurthe
rnu
rsinged
ucation
Crawford
[32]
2011
Using
prob
lem-based
learning
inweb
-based
compo
nentsof
nurse
education
Nurse
Educationin
Practice
Australia
Qualitative
Nursing
stud
ents
PBLapproaches
inon
line
education
Stud
entsaccessingon
linenu
rsingsubjects
wou
ldseem
tobe
nefit
from
web
-based
PBL
asitprovides
flexibility,op
portun
ities
fordis-
cussionandco-participation,en
courages
stu-
dent
autono
my,andallowsconstructio
nof
meaning
astheprob
lemsmirror
thereal
world.PBL
also
prom
otes
criticalthinking
andtransfer
oftheo
ryto
practice.
Davidson
[33]
2016
Teaching
EBPusing
game-basedlearning
:Im
provingthestud
ent
expe
rience
Worldview
son
eviden
ce-
basednu
rsing
Canada
Qualitative
Nursing
stud
ents
OnlineEBPcourse
Stud
entsindicatedahigh
satisfactionwith
thecourse
andstud
enten
gage
men
twas
also
maintaine
dthroug
hout
thecourse.
Daw
ley[34]
2011
Using
ape
dago
gical
Worldview
son
eviden
ce-
USA
Qualitative
Nursing
stud
ents
Pedago
gicalapp
roachaimed
Theassign
men
twas
anim
portantteaching
Larsen et al. BMC Medical Education (2019) 19:259 Page 7 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
approach
tointegrate
eviden
ce-based
teaching
inan
unde
rgradu
ate
wom
en’she
alth
course
basednu
rsing
at[1]fostering
unde
rgradu
atenu
rsing
stud
ents’EBP
compe
tencies,
and[2]iden
tifying
gaps
intheliteratureto
direct
future
wom
en’she
alth
research
andassessmen
ttool
forEBP.
Dew
ar[35]
2012
TheEBPcourse
asan
oppo
rtun
ityforwriting
Nurse
Educator
USA
Qualitative
Nursing
stud
ents
Writingworksho
psTheworksho
papproach
provides
stud
ents
with
a“safe”
placeto
exploretheir
assumptions,learn
from
peers,andmakea
leap
forw
ardalon
gtheirpe
rson
allearning
curveas
writers.
Doyle[36]
2016
Inform
ationLiteracy
ina
DigitalEra:
Und
erstanding
the
Impact
ofMob
ileInform
ationfor
Und
ergraduate
Nursing
Stud
ents
Book
chapterin:N
ursing
Inform
atics2016:eHealth
for
All:EveryLevelC
ollabo
ratio
n–From
Projectto
Realization
Canada
Qualitative
Nursing
stud
ents
Use
ofmob
ileinform
ation
resources
Nursing
stud
entsmainlyassessed
mob
ileresourcesto
supp
ortclinicallearning
,and
specifically
fortask-oriented
inform
ationsuch
asdrug
med
icationor
patient
cond
ition
s/diagno
ses.Researchersrecommen
dapara-
digm
shift
whe
reby
educatorsem
phasisein-
form
ationliteracyin
away
that
supp
orts
eviden
ce-based
quality
care.
Eales-
Reynolds
[37]
2012
Astud
yof
the
developm
entof
critical
thinking
skills
Nurse
EducationToday
Australia
Qualitative
Nursing
stud
ents
andstud
ents
from
othe
rhe
althcare
disciplines
Ano
velw
eb2.0-basedtool
–theWeb
Resource
App
raisal
Process(W
RAP)
Toen
sure
that
practicede
velopm
entsare
basedon
authoritativeeviden
ce,stude
nts
need
tode
velopcriticalthinkingskillswhich
may
befacilitated
bytoolssuch
asthe
WRA
P.
ElsborgFoss
[38]
2014
Amod
el(CMBP)for
collabo
ratio
nbe
tween
university
college
and
nursingpracticeto
prom
oteresearch
utilizatio
nin
stud
ents’
clinicalplacem
ents:a
pilotstud
y
Nurse
Educationin
Practice
Norway
Quantitative
Nursing
stud
ents
CMBP
(The
Collabo
ratio
nMod
elof
BestPractice)
TheCMBP
hasapo
tentialtobe
auseful
mod
elforteaching
RNs’andstud
entsEBP.
How
ever,further
refinem
entof
themod
elis
need
ed.
Epstein[39]
2011
Teaching
Statisticsto
Und
ergraduate
Nursing
Stud
ents:A
nIntegrative
Review
toInform
our
Pedago
gy
InternationalJou
rnalof
Nursing
Education
Scho
larship
USA
Qualitative
Nursing
stud
ents
Learning
strategies:
Sche
maticlinks
betw
een
statisticsandeveryday
nursingpractice.
Techno
logicalStrateg
ies:use
ofdata
analysissoftware
(Excel,SPSSetc.)+
useof
the
Internet.G
roup
learning
activities:Smallg
roup
/worksho
pactivities.Sup
port:
stud
ent,faculty,−
and
labo
ratory
supp
ort
Itwas
foun
dthat
thereislim
ited-to-noevi-
denceconcerning
thepe
dago
gyof
statistics.
Erichsen
[40]
2018
Kunn
skapsbasertpraksis
isykep
leierutdanning
enSykepleien
Forskningnr.
12,016
Norway
Qualitative
Nursing
stud
ents
Descriptio
nof
learning
-activities
includ
ingallsteps
inteaching
andcond
uctin
g
System
atictraining
inEBPin
coop
eration
with
thepracticefield
canhave
apo
sitive
impact
onstud
ents’learning.
More
Larsen et al. BMC Medical Education (2019) 19:259 Page 8 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
EBP
internationaland
Norweg
ianresearch
with
different
stud
yde
sign
sisne
cessaryto
increase
theknow
ledg
e.
Florin
[41]
2012
Educationalsup
portfor
research
utilizatio
nand
capability
beliefsregarding
eviden
ce-based
practice
skills:anatio
nalsurvey
ofsenior
nursing
stud
ents
Journalo
fAdvancedN
ursing
Swed
enQuantitative
Nursing
stud
ents
Educationalsup
portfor
research
utilisatio
nand
capabilitybe
liefsregarding
EBPskills
Stud
entsrepo
rted
high
capabilitybe
liefs
regardingeviden
ce-based
practiceskills,bu
tlargedifferences
werefoun
dbe
tweenun
i-versities
for:statingasearchablequ
estio
n,seekingou
trelevant
know
ledg
eandcritically
appraising
andcompilingbe
stknow
ledg
e.
Friberg[42]
2013
Chang
ingEssayWriting
inUnd
ergraduate
Nursing
Education
Throug
hAction
Research:A
Swed
ish
Exam
ple
Nursing
Education
Perspe
ctives
Swed
enQualitative
Nursing
stud
ents
Worksho
psandliterature
review
Actionresearch
was
foun
dto
bearelevant
proced
ureforchanging
waysof
working
with
literature-based,
bachelor
degree
essays.
Gray[43]
2010
Research
odyssey:The
evolutionof
aresearch
partne
rshipbe
tween
baccalaureaten
ursing
stud
entsandpracticing
nurses
Nurse
educationToday
USA
Quantitative
Nursing
stud
ents
Aresearch
partne
rship
betw
eenbaccalaureate
nursingstud
entsandnu
rses
intw
oacutecare
hospitals
Theresearch
partne
rshipprojectfacilitated
stud
entlearning
andan
appreciatio
nof
the
research
process.
Hande
[44]
2017
LevelingEviden
ce-based
PracticeAcrosstheNurs-
ingCurriculum
TheJournalfor
Nurse
Practitione
rs-JNP
USA
Qualitative
Nursing
stud
ents
Thearticlede
scrib
esevolving
EBPcompe
tenciesrelatedto
BSN,M
SN,and
DSN
level.BSN
level:Team-based
learning
,seminars,sm
allg
roup
activities,ide
ntificatio
nof
clinicalprob
lems,literature
search,app
raisalof
literature,
eviden
ce-based
projectad-
dressing
aselected
clinical
prob
lem
forthepu
rposes
ofim
provingclinicalou
tcom
es
Seam
less
transitio
nforthede
velopm
entof
EBPcompe
tenciesfornu
rses
ateach
levelo
fed
ucationrequ
iresthou
ght,strategically
placed
objectives
andlearning
activities
tobe
woven
into
thecurriculum
andcourses.
Collabo
ratio
nam
ongfaculty
from
each
educationallevelmustoccur.Teaching
-learning
metho
dsmustbe
approp
riate
and
engaging
ateach
level.Teaching
-learning
metho
dsmustchalleng
ethestud
entto
applyandprod
ucescho
larly
workfor
dissem
ination
Hen
och[45]
2014
Nursing
stud
ents’
expe
riences
ofinvolvem
entin
clinical
research:anexploratory
stud
y
Nurse
Educationin
Practice
Swed
enQuantitative
Nursing
stud
ents
Stud
entsinvolved
asdata
collectorsin
aresearch
project
Participationas
data
collectorsin
research
hasthepo
tentialtoincrease
interestin
nursingresearch
amon
gstud
ents.
Hickm
an[46]
2014
EVITEA
CH:A
stud
yexploringwaysto
optim
isetheup
take
ofEBPto
unde
rgradu
ate
nurses
Nurse
Educationin
Practice
Australia
Mixed
metho
dNursing
stud
ents
EVITACHto
explorestrategies
toincrease
unde
rgradu
ate
nursingstud
ent’s
engage
men
twith
EBPand
toen
hancetheirknow
ledg
eutilisatio
nandtranslation
capabilities
Thereislittle
robu
steviden
ceto
guidethe
mosteffectiveway
tobu
ildknow
ledg
eutilisatio
nandtranslationalskills.Effectively
engaging
unde
rgradu
atenu
rsingstud
entsin
know
ledg
etranslationandutilisatio
nsubjectscouldhave
immed
iate
andlong
term
bene
fitsfornu
rsingas
aprofession
and
Larsen et al. BMC Medical Education (2019) 19:259 Page 9 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
patient
outcom
es.
Jakube
c[47]
2013
Stud
entsCon
necting
CriticalApp
raisalto
EPB:
ATeaching
-LearningAc-
tivity
forResearch
Literacy
Journalo
fNursing
Education
Canada
Qualitative
Nursing
stud
ents
TheResearch
inPractice
Challeng
einclud
ing
iden
tifying
research
prob
lemsin
practice,
searchingtheliterature,and
critically
evaluatin
geviden
ce
Stud
entsvalueho
wtheactivity
high
lighted
therelevanceof
research
literacyfortheir
practice.
Jalali-Nia
[48]
2011
Effect
ofeviden
ce-based
educationon
Iranian
nursingstud
ents’kno
w-
ledg
eandattitud
e
Nursing
andHealth
Sciences
Iran
Quantitative
Nursing
stud
ents
Eviden
ce-based
approach
incl.The
principles
ofEBP
andPICO.The
interven
tion
andthecontrolg
roup
s,respectively,weretaug
htthroug
han
eviden
ce-based
andtradition
alapproach
Sign
ificant
differencebe
tweentheaverage
scores
forattitud
eof
thegrou
ps.N
ostatisticalsign
ificant
differencebe
tweenthe
averagescores
ofknow
ledg
e.
Janke[49]
2012
Prom
otinginform
ation
literacythroug
hcollabo
rativeservice
learning
inan
unde
rgradu
ateresearch
course
Nurse
EducationToday
Canada
Qualitative
Nursing
stud
ents
Servicelearning
project
whe
restud
entsworkedin
grou
ps,and
unde
rthe
guidance
ofanu
rsing
instructor
andlibrarian,to
answ
eraqu
estio
npo
sedby
practice-basedpartne
rs
Evaluatio
nof
theprojectindicatedthat
althou
ghtheprojectwas
challeng
ingand
labo
urintensivestud
entsfeltthey
learne
dim
portantskillsfortheirfuture
practice.
Jelsne
ss-
Jørgen
sen
[50]
2014
Doe
sa3-weekcritical
research
appraisalcou
rse
affect
how
stud
entspe
r-ceivetheirappraisalskills
andtherelevanceof
re-
search
forclinicalprac-
tice?
Arepe
ated
cross-
sectionalsurvey
Nurse
EducationToday
Norway
Quantitative
Nursing
stud
ents
andstud
ents
from
othe
rhe
althcare
disciplines
A3-weekcriticalresearchap-
praisalcou
rse
Teaching
stud
ents’p
racticalcriticalapp
raisal
skillsim
proved
theirview
oftherelevanceof
research
forpatients,future
workas
wellas
theirow
ncriticalapp
raisalskills.
John
son
[51]
2010
Research
andEBP:using
ablen
dedapproach
toteaching
andlearning
inun
dergradu
atenu
rse
education
Nurse
Educationin
Practice
England
Qualitative
Nursing
stud
ents
Adiscussion
ofon
emod
ule
team
’sexpe
rienceof
working
inaHighe
rEducation
Institu
tionwith
intheUK,
teaching
research
andEBPto
year
twoun
dergradu
ate
nursingandmidwifery
stud
ents
Theuseof
ablen
dedapproach
toteaching
andlearning
canbe
bene
ficialtothenu
rse
educator
inavariety
ofwaysifcareful
considerationisgivento
theuseof
techno
logy,the
learning
styles
ofthe
stud
entandaccess
totechno
logy.
Jone
s[52]
2011
Teaching
critical
appraisalskills
for
nursingresearch
Nurse
Educationin
Practice
Australia
Quantitative
Nursing
stud
ents
Aninno
vativeandqu
ality
driven
subjectto
improve
criticalapp
raisalandcritical
thinking
skills
Stud
entsfro
mbo
thcampu
sesshow
edconsiderableim
provem
entsin
know
ledg
eandconfiden
cein
theinterpretatio
nand
analysisof
research
finding
s,in
allareas
after
having
completed
thesubject(assessm
ent).
Keiffer
[53]
2018
Engaging
Nursing
Stud
ents:Integ
ratin
gEviden
ce-Based
Inqu
iry,
Inform
atics,andClinical
Practice
Nursing
Education
Perspe
ctives
USA
Qualitative
Nursing
stud
ents
Worksho
pform
aten
gage
sthestud
entswith
techno
logy
anddigitaltoo
lsto
prom
oteactivelearning
;en
hancestud
ent
Well-d
esigne
dcurricularequ
ireim
agination,
creativity,and
team
effortbe
tweentheo
ryandclinicalfaculty.D
esigning
projects
applicableto
theclinicalsite
provides
anaven
ueforstud
entsto
engage
inEBPwhile
Larsen et al. BMC Medical Education (2019) 19:259 Page 10 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
collabo
ratio
nand
participation.Varying
teaching
mod
alities
are
employed
toen
gage
stud
entsandreinforce
learning
.The
stud
entsare
usingtheMelnyket
al.
mod
elas
aframew
ork;aska
clinicalqu
estio
nusingthe
PICO
Tcriteria,d
evelop
strategies
tosearch,app
raise
research,use
eviden
ceto
inform
clinicalde
cision
-making,
design
achange
,anddissem
inatethe
eviden
ce
demon
stratin
gtheachievem
entof
course
learning
outcom
es.
Kiekkas[54]
2015
Nursing
stud
ents’
attitud
estoward
statistics:Effect
ofa
biostatisticscourse
and
associationwith
exam
ination
perfo
rmance
Nurse
EducationToday
Greece
Quantitative
Nursing
stud
ents
Biostatisticscourse
Stud
ents’attitu
destowardstatisticscanbe
improved
throug
happrop
riate
biostatistics
courses,whilepo
sitiveattitud
escontrib
ute
tohigh
ercourse
achievem
entsandpo
ssibly
toim
proved
statisticalskillsin
later
profession
allife.
Kyriakoulis
[10]
2016
Educationalstrateg
ies
forteaching
EBPto
unde
rgradu
atehe
alth
stud
ents:systematic
review
Journalo
fEdu
catio
nal
Evaluatio
nforHealth
Profession
s
USA
Quantitative
Nursing
stud
ents
andstud
ents
from
othe
rhe
althcare
disciplines
Lectures,tutorials,w
orksho
ps,
conferen
ces,journalclubs,
andon
linesessions
orcombinatio
nof
these
Multifaceted
approach
may
bebe
stsuited
whe
nteaching
EBM
tohe
alth
stud
ents.
Leach[55]
2016
Theim
pact
ofresearch
educationon
stud
ent
nurseattitud
e,killand
uptake
ofeviden
ce
Journalo
fClinicalNursing
Australia
Quantitative
Nursing
stud
ents
Research
education
prog
rammede
livered
astw
oeigh
t-weekcoursesin
the
third
year
ofed
ucation
Research
educationmay
have
asign
ificant
effect
onnu
rsingstud
ents’researchskillsand
useof
EBP,andminim
isebarriersto
EBP
post-edu
catio
n.
Lewis[56]
2016
Dim
inishing
Effect
Sizes
with
Repe
ated
Expo
sure
toEBPTraining
inEntry-
LevelH
ealth
Profession
alStud
ents:A
Long
itudinal
Stud
y
PhysiotherapyCanada
Canada
Quantitative
Physiotherapy
stud
entsand
stud
entsfro
mothe
rhe
althcare
disciplines
Twosequ
entialEBP
courses.
1.EBPcourse
was
aimed
atde
veloping
foun
datio
nal
know
ledg
eof
andskillsin
thefivestep
sin
EBP.2.EBP
course
design
edto
teach
stud
entsto
applythestep
s
Know
ledg
eandrelevancechange
dmost
meaning
fully
(i.e.,sho
wed
thelargesteffect
size)forparticipantswith
minim
alprior
expo
sure
totraining
.Chang
esin
participants’
confiden
ceandattitud
esmay
requ
irea
long
ertim
eframeandrepe
ated
training
expo
sure.
Liou
[57]
2013
Inno
vativestrategies
for
teaching
nursing
research
inTaiwan
Nursing
Research
Taiwan
Quantitative
Nursing
stud
ents
Inno
vativeTeaching
Strategies
foraresearch
course
includ
ingteam
work,
labo
ratory
sessions
onho
wto
search
forpu
blishe
dresearch
articles,expe
rimen
tsandminiresearchprojects
(experim
entalg
roup
).Didactic
lecture,textbo
okreadings,
Thisstud
yconfirm
edthat
usinginno
vative
teaching
strategies
innu
rsingresearch
coursesen
hances
stud
entinterestand
enthusiasm
abou
tEBP.
Larsen et al. BMC Medical Education (2019) 19:259 Page 11 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
andresearch
articlecritiqu
e(con
trol
grou
p)
Laaksone
n[58]
2013
Journalclubas
ametho
dfornu
rses
and
nursingstud
ents’
collabo
rativelearning
:ade
scrip
tivestud
y
Health
ScienceJournal
Finland
Quantitative
Nursing
stud
ents
Asix-ph
ased
journal
club
mod
elJournalclubs
supp
ortcompe
tences
and
discussion
requ
iredforprod
ucingeviden
ce-
basedcare
andcanbe
recommen
dedas
learning
metho
dsfornu
rses’and
nursing
stud
ents’collabo
rativelearning
.
Malik[59]
2017
Using
pedago
gical
approaches
toinfluen
ceeviden
ce-based
practice
integration-processes
andrecommen
datio
ns:
finding
sfro
ma
grou
nded
theo
rystud
y
Journalo
fAdvancedNursing
(JAN)
Australia
Qualitative
Nurse
academ
ics
(regarding
nursingstud
ents)
Vario
uspe
dago
gical
approaches
toinfluen
ceeviden
ce-based
practiceed
u-catio
n;lectures,tutorials,la-
boratory
work,on
line
activities,video
s,scen
arios,
andassign
men
ts.Emph
asis-
inginform
ationliteracyand
criticalapp
raisalskills.Some
useflipp
edclassroo
map-
proach,p
roblem
-based
learn-
ing,
virtualsim
ulated
environm
ent,andinqu
iry-
basedlearning
tofacilitate
stud
ents’learning
Acade
micsattempted
tocontextualiseEBP
byen
gaging
stud
entswith
activities
aiming
tolinkeviden
ceto
practiceandwith
theEBP
practice.Engaging
stud
entswith
theEBP
processin
practicecontextisim
perativeto
increase
theirEBPcompe
tence.Somekey
challeng
es(limitedtim
e,insufficien
tresources,he
avyworkload,
stud
ents’
diseng
agem
ent,andlim
itedaw
aren
essof
effectiveteaching
metho
ds)requ
irethe
adop
tionof
approp
riate
strategies
toen
sure
future
nurses
arewellp
reparedin
the
paradigm
ofeviden
ce-based
practice
Mattila[60]
2014
Journalclubinterven
tion
inprom
otingeviden
ce-
basednu
rsing:
Percep
-tio
nsof
nursingstud
ents
Nurse
Educationin
Practice
Finland
Quantitative
Nursing
stud
ents
Journalclubs
Stud
entswereno
tableto
utilise
thestud
ies
tothesameextent
asthey
learnfro
mthem
.Age
,workexpe
rienceandparticipationin
research
andde
velopm
entactivities
were
conn
ectedto
learning
.
McCurry
[61]
2010
Teaching
unde
rgradu
ate
nursingresearch:a
comparison
oftradition
aland
inno
vativeapproaches
forsuccesswith
millen
niallearne
rs
Journalo
fNursing
Education
USA
Mixed
metho
dNursing
stud
ents
Inno
vativeassign
men
tsthat
includ
edinteractivelearning
,grou
pwork,andpractical
applications
Stud
ents’p
ositive
respon
sesto
the
inno
vativelearning
strategies
evaluatedin
thisstud
ysupp
ortthenu
rsingprofession
’sne
edto
continue
tode
velopactivities
that
engage
millen
nialstud
entsanden
ablethem
toclearly
articulatethevalueof
theresearch
practicelinkvitaltoeviden
ce-based
nursing
practice.
Milner
[62]
2017
ThePICOGam
e:An
Inno
vativeStrategy
for
Teaching
Step
1in
Eviden
ce-Based
Practice
Worldview
son
Eviden
ce-
BasedNursing
USA
Qualitative
Nursing
stud
ents
Gam
eGam
esbu
ildandstreng
then
skillsto
frame
practicequ
estio
nsin
asearchableform
at(PICO).Themetho
dforteaching
how
tobu
ildPICOqu
estio
nsisthesameregardless
ofparticipanted
ucationlevelo
ryearsof
practice
Moch[63]
2010
PartII.Em
powering
grassroo
tsEBP:a
curricular
mod
elto
foster
unde
rgradu
ate
stud
ent-en
abledpractice
change
Journalo
fprofessional
nursing
USA
Qualitative
Nursing
stud
ents
The“Stude
nt-Enabled
PracticeChang
eCurricular
Mod
el”
Astheprelim
inarydata
repo
rted
here
sugg
est,nu
rseed
ucatorshave
thepo
wer
toprom
otepracticechange
byen
abling
sociallymeaning
fulp
artnershipsbe
tween
stud
entsandpracticingnu
rses
that
could
percolatechange
upfro
mthelowestpo
ints
Larsen et al. BMC Medical Education (2019) 19:259 Page 12 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
inthepo
wer
hierarchy.
Moch[64]
2010
PartI.Und
ergraduate
nursingEBPed
ucation:
envision
ingtheroleof
stud
ents...firstof
athree-partseries
Journalo
fprofessional
nursing
USA
Qualitative
Nursing
stud
ents
Vario
uspe
dago
gical
strategies
targeted
towards
teaching
EBP
Theliteraturereview
edin
thisarticlethat
describ
esmoreactiverolesforstud
entsin
clinicalsettings,albeitscant,sugg
eststhat
allowingstud
entsto
interact
inon
-going
andmeaning
fulw
ayswith
practicingnu
rses
may
removeor
mitigate
barriersto
the
adop
tionof
EBPam
ongpracticingnu
rses.
Morris
[65]
2016
Theuseof
team
-based
learning
inasecond
year
unde
rgradu
atepre-
registratio
nnu
rsing
course
oneviden
ce-
inform
edde
cision
making
Nurse
Educationin
Practice
England
Mixed
metho
dNursing
stud
ents
Eviden
ce-in
form
edde
cision
makingcourse
Team
-based
learning
was
show
nto
bean
effectivestrategy
that
preservedthebe
nefits
ofsm
allg
roup
teaching
with
largestud
ent
grou
ps.
Morris
[66]
2010
Pilotstud
yto
testthe
useof
amob
ilede
vice
intheclinicalsettingto
access
eviden
ce-based
practiceresources
World
View
son
Eviden
ce-
basedNursing
England
Quantitative
Nursing
and
physiotherapy
stud
ents
Use
ofmob
ilede
vice
toaccess
EBPresourcesin
clinicalsetting
Stud
entsrepo
rted
improvem
entin
know
ledg
eandskillsin
relatio
nto
EBPand
appraisalo
fclinicalgu
idelines.H
owever
alow
levelo
futilisatio
nof
themob
ilede
vice
intheclinicalsettingdu
eto
access
tothe
internet
andsm
allscreens.
Nadelson
[67]
2014
Eviden
ce-Based
Practice
ArticleReview
sUsing
CASP
Tools:AMetho
dforTeaching
EBP
Worldview
son
eviden
ce-
basednu
rsing
USA
Qualitative
Nursing
stud
ents
EBPArticleReview
susing
CASP
Tools
Using
theCASP
Toolshe
lpstud
entsorganise
theirreview
sandlearnabou
tvaluable
resources.In
additio
n,working
asagrou
pmem
berhe
lpsfoster
involvem
ent,
motivation,andinterestin
theprocessesof
evaluatin
geviden
ceeffectively.
Nadelson
[68]
2014
Onlineresources:
fosteringstud
entsEBP
learning
throug
hgrou
pcriticalapp
raisals
World
view
son
Eviden
ce-
basedNursing
USA
Qualitative
Nursing
stud
ents
Stud
entsin
dyadsor
triads
review
edandevaluatedon
eEBPrelatedweb
site
Havingstud
entsworkin
grou
psto
critically
appraise
web
sitesthat
help
prom
oteEBPcan
enhancecollabo
ratio
nandknow
ledg
eabou
tEBPresources.
Niven
[69]
2013
Makingresearch
real:
Embe
ddinga
long
itudinalstudy
ina
taug
htresearch
course
forun
dergradu
ate
nursingstud
ents
Nurse
EducationToday
USA
Qualitative
Nursing
stud
ents
Tofacilitatestud
entslearning
research
theo
ryand
metho
dology
bycond
uctin
ga“real-life”research
stud
yin
alocalretiremen
tcommun
ity
Weknew
wehadsucceede
din
oureffortsto
change
stud
entpe
rcep
tions
abou
tlearning
research
whe
nweread
acommen
tfro
mon
estud
entwho
hadcompleted
therevised
research
course.
O’Neil[70]
2016
Ane
wmod
elin
teaching
unde
rgradu
ate
research:A
collabo
rative
approach
andlearning
coop
eratives
(CALC
)
Nurse
Educationin
Practice
USA
Qualitative
Nursing
stud
ents
Aqu
ality
improvem
entstud
yusingtheCALC
Mod
elUniversities
andho
spitaladm
inistrators,
nurses,and
stud
entsbe
nefit
from
working
toge
ther
andlearning
from
each
othe
r.
Ode
ll[71]
2011
Teaching
EBP:The
Bachelor
ofSciencein
Nursing
Essentialsat
Workat
theBedside
Journalo
fprofessional
nursing
USA
Qualitative
Nursing
stud
ents
Agrou
pprojectforstud
ents
that
involved
collabo
ratio
nwith
thehe
alth
science
referencelibrarianandnu
rse
Thelearning
expe
rienceisashared
partne
rshipbe
tweentheclinicalagen
cy,the
faculty,and
thehe
alth
sciencelibrarianto
assistsenior
nursingstud
entsin
thelast
Larsen et al. BMC Medical Education (2019) 19:259 Page 13 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
managersin
theclinical
agen
cies
semesterof
theirbaccalaureatede
gree
prog
rammeto
synthe
sise
andusethe
know
ledg
e,skills,andattitud
esthat
prom
ote
patient
safety
andop
timalou
tcom
es
Oja[72]
2011
Using
prob
lem-based
learning
(PBL)in
the
clinicalsettingto
im-
provenu
rsingstud
ents’
criticalthinking:
anevi-
dencereview
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
PBL
Thestud
iesreview
edindicate
apo
sitive
relatio
nshipbe
tweenPBLandim
proved
criticalthinkingin
nursingstud
ents.
Penn
ington
[73]
2010
EBPpartne
rships:
buildingbridge
sbe
tweened
ucationand
practice
Nursing
Managem
ent
USA
Qualitative
Nursing
stud
ents
Team
ingnu
rsingstud
ents
with
staffnu
rses
working
onEBPprojects
Stud
entswereableto
learnho
weviden
ceis
utilisedin
thepracticesettings.
Phelps
[74]
2015
Introd
ucingInform
ation
Literacy
Com
petency
StandardsforNursing
Nurse
educator
USA
Qualitative
Nursing
stud
ents
Inform
ationLiteracy
Com
petencyStandardsfor
Highe
rEducation(ILCSH
E)
Nursing
librarians
aretheInform
ation
Literacy
expe
rtswho
help
tointegratethese
skillsinto
nursinged
ucation
Phillips[75]
2014
Creativeclassroo
mstrategies
forteaching
nursingresearch
Nurse
Educator
USA
Qualitative
Nursing
stud
ents
Kaleidoscope
sfordiscussion
ofpe
rspe
ctives,crossword
puzzlesto
reinforce
term
inolog
y,scaven
gerhu
ntto
relate
concep
tsto
thereal
world,coo
kieexpe
rimen
tto
have
anoverview
ofthe
research
processand
paradigm
s,individu
alreactio
ntim
e,andamusic
activity
toreinforceelem
ents
ofde
sign
andsampling
Stud
entfeed
back
was
positive.These
strategies
help
faculty
commun
icate
impo
rtantconcep
tsof
nursingresearch
ina
way
that
ismeaning
fuland
fun.
Pierce
[76]
2016
Thee-Po
ster
Con
ference:
AnOnlineNursing
Re-
search
Cou
rseLearning
Activity
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
e-po
ster
conferen
ceFrom
allaccou
nts,theconferen
cewas
rated
aspo
sitive,providingnu
rsingstud
entswith
oppo
rtun
ities
to(a)view
stud
iesandprojects
from
awider
nursingscienceaudien
ce,(b)
foster
thede
velopm
entof
impo
rtant
evaluatio
nandcommun
icationskills,and(c)
beexpo
sedto
eviden
cethat
couldbe
translated
into
theirpractice.
Putnam
[77]
2011
Con
queringEBPusing
anem
bedd
edlibrarian
andon
linesearch
tool
Journalo
fNursing
USA
Qualitative
Nursing
stud
ents
Embe
dded
librarians
+on
linesearch
toolsto
assist
stud
entsin
thede
velopm
ent
andmastery
ofeffective
search
techniqu
es
Embe
dded
librarians
andon
linesearch
tools
areuseful
tostud
entsas
they
develop
inform
ationliteracyskillsrelatedto
searching
forandscreen
inginform
ation.Using
these
strategies
forform
ativeandsummative
assign
men
tsallowsstud
entsto
develop
additio
nalinformationliteracyskillsne
eded
tointegrate,analyse,apply,andpresen
tinform
ation.
Raines
[78]
2016
Acollabo
rativestrategy
Worldview
son
eviden
ce-
USA
Qualitative
Nursing
stud
ents
Ateaching
strategy
which
Theteaching
strategy
presen
tsawin-w
in
Larsen et al. BMC Medical Education (2019) 19:259 Page 14 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
tobringeviden
ceinto
practice
basednu
rsing
combine
stheclinical
expe
rienceof
nurses
with
nursingstud
ents’evolving
skillsin
reading,
critiqu
ing,
andanalysingresearch-based
literature
situationin
which
stud
entsbe
comeen
gage
dwith
clinicalnu
rses
inaun
it-basedproject.
Raurell-
Torred
a[79]
2015
Simulation-based
learning
asatacticfor
teaching
EBP
Worldview
son
eviden
ce-
basednu
rsing
Spain
Qualitative
Nursing
stud
ents
Simulation-basedlearning
(SBL)mod
ules
coverin
gnu
rsingcompe
tencies
Thesimulationhe
lped
toed
ucatenu
rsing
stud
entsin
applying
EBP.
Reiche
rter
[80]
2013
Creatingdissem
inator
cham
pion
sforEBPin
health
profession
sed
ucation:An
educationalcaserepo
rt
Nurse
EducationToday
USA
Qualitative
Nursing
and
physiotherapy
stud
ents
Amod
elforde
veloping
EBP
practitione
rs:Phase
1.Prep
aringstud
entsho
wto
read,analyse
anddiscuss
levelsof
eviden
ce.Phase
2.Focuson
developing
dissem
inationskillsby
requ
iring
stud
entsto
completeaclinicalcase
repo
rtproject.Ph
ase3.
Review
outcom
esof
the
projectandph
ase4.Provide
mechanism
sof
future
plans
Increasedstud
entparticipation,Clinical
instructorsandfaculty
scho
larship,
and
dissem
inationof
EBP.Add
ition
aled
ucational
bene
fitsde
rived
from
thisprojectinclud
ed,
1)broade
rparticipationof
clinicalsettings,2)
requ
estsby
additio
nalclinicsto
participate
forpu
rposes
ofde
veloping
EBPandscho
larly
presen
tatio
nskillsof
clinicians,and
3)increasedop
portun
ityforacadem
icfaculty
tocontinue
engage
men
tin
contem
porary
clinicalpractice.
Revaitis[81]
2013
FaceTime:avirtual
pathway
betw
een
research
andpractice
Nurse
Educator
USA
Qualitative
Nursing
stud
ents
FaceTimevide
ocon
ference
FaceTimevide
ocon
ferencingprovides
numerou
sbe
nefitsforstud
entsandprovides
avirtualcon
nectionto
linktheclassroo
mwith
thepracticeworld.
Robe
rts[82]
2011
Find
ingandusing
eviden
cein
academ
icassign
men
ts:The
bane
ofstud
entlife
Nurse
Educationin
Practice
England
Quantitative
Nursing
stud
ents
Specificsessions
onliterature
searchingskillswhich
were
delivered
early
onin
the
prog
ramme
Thefinding
sindicate
that
stud
entsvalue
specificteaching
sessions
(taugh
tby
mem
bersof
library
staff)de
livered
atthe
beginn
ingof
theprog
rammebu
titseem
sthat
moreworkisrequ
iredby
educatorsin
orde
rto
help
stud
entsto
associateliterature
searchingskillswith
nursingpractice.
Rodriguez
[83]
2012
ActionResearch
asa
Strategy
forTeaching
anUnd
ergraduate
Research
Cou
rse
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
Teaching
ofActionResearch
insteadof
teaching
tradition
alresearch
course
metho
ds
Thestud
entslearne
dho
wto
iden
tifya
research
prob
lem
andmovethroug
hthe
step
sof
theresearch
processusingactio
nresearch.
Rolloff[84]
2010
Aconstructivistmod
elforteaching
EBP
Nursing
Education
Perspe
ctives
USA
Qualitative
Nursing
stud
ents
Con
structivistMod
elwith
sugg
estio
nsof
teaching
EBP
principles
durin
gallb
ache
lor
years
Theconstructivisttheo
ryforlearning
may
provideaframew
orkforarede
sign
edbaccalaureatecurriculum
,one
that
supp
orts
EBPthroug
hout
anu
rsingstud
ent’s
education.
Ruskjer[85]
2010
Areal-w
orld
expe
rience
toen
gage
stud
entsin
EBP
Journalo
fNursing
Education
USA
Qualitative
Nursing
stud
ents
1.Practicingnu
rses
subm
itclinicalqu
estio
ns,2.Stude
nts
attend
seminar
incl.EBP
review
process+source
ofeviden
ce,3.Stude
ntsselect
Using
eviden
ceto
answ
erbu
rningqu
estio
nsstraight
from
theclinicalsettings
isan
effectiveway
toen
gage
stud
entsandstaff
nurses
inEBP.
Larsen et al. BMC Medical Education (2019) 19:259 Page 15 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
clinicalqu
estio
n,appraise
system
aticreview
sandothe
rliterature,4.Faculty
consult
stud
entsincl.Introdu
ctionto
PICO
,5.Stude
ntswrite
abstractsandmakepo
wer
pointandpo
ster
Ruzafa-
Martin
ez[86]
2016
Effectiven
essof
anEBP
course
ontheEBP
compe
tenceof
unde
rgradu
atenu
rsing
stud
ents:A
quasi-
expe
rimen
talstudy
Nurse
EducationToday
Spain
Quantitative
Nursing
stud
ents
A15-w
eekcourse
design
edto
teachEBPcompe
tence
Und
ergraduate
nursingstud
entsexpe
rience
positivechange
sin
EBPcompe
tence,
know
ledg
e,skills,andattitud
eas
theresult
ofa15-w
eeked
ucationalinterventionon
EBP.
Schams[87]
2010
ClinicalPo
st-con
ference
Pedago
gy:Explorin
gEBP
With
Millen
nial-In
spired
‘BuildingBlocks’
Creativenu
rsing
USA
Qualitative
Nursing
stud
ents
Inno
vativeteaching
strategy
consistin
gof
learning
units
whe
reby
stud
entscometo
post-con
ferencesessions
pre-
paredto
shareEBPinform
a-tio
nassociated
with
upcominglabo
ratory
con-
cepts,discover
relatio
nships
amon
glabo
ratory
concep
tsandcurren
tnu
rsingpractice,
andassociatepe
rson
alclin-
icalexpe
riences
with
the
practiceen
vironm
ent
Stud
entsde
mon
stratedmoreconfiden
cein
questio
ning
curren
tpractice,researchingEBP
literature,andworking
ingrou
ps.The
BuildingBlocks
teaching
strategy
provided
aninno
vativeway
toen
gage
stud
ents
durin
gpo
st-con
ferences
toconn
ectpractice
concep
tsto
real-life
expe
riences,and
pro-
moted
theuseof
EBPin
guidingpractice
decision
s.
Schreine
r[88]
2015
How
unde
rgradu
ate
stud
entscancontrib
ute
toEBP
Nursing
Managem
ent
Canada
Qualitative
Nursing
stud
ents
Partne
rshipbe
tween
university
andho
spital
working
toge
ther
onEBP-
projects
Stud
entsinvolved
inthepilotprog
ramme
expand
edtheirresearch
horizon
andlearne
dto
cond
uctliteraturereview
s,utilize
search
engine
s,andcatego
rizearticles.Being
involved
inclinicalresearch
canbe
anasset
toun
dergradu
atestud
entsforfuture
practice
anded
ucation.
Scott[89]
2011
Acollabo
rativeteaching
strategy
foren
hancing
learning
ofeviden
ce-
basedclinicalde
cision
-making
Journalo
fAllied
Health
USA
Qualitative
Occup
ational
-and
physiotherapy
stud
ents
Partne
rshipbe
tween
university
andho
spital
Theapproach
increasedstud
entmotivation
andgreatly
enhanced
thelearning
expe
rience.
Scurlock-
Evans[90]
2017
Toem
bedor
notto
embe
d?Along
itudinal
stud
yexploringthe
impact
ofcurriculum
design
ontheeviden
ce-
basedpracticeprofiles
ofUKpre-registratio
nnu
rsingstud
ents
Nurse
Educationtoday
UK
Quantitative
Nursing
stud
ents
Thisstud
ycomparedthe
impact
ofem
bedd
ingEBP
throug
hout
thecurriculum
,with
mod
ular-based
teach-
ing,
onpre-registratio
nnu
rs-
ingstud
ents’EBP
profiles.
Taking
amod
ular
orem
bedd
edapproach
toEBPmay
have
little
impact
onstud
ents’final
EBPprofiles
Sin[91]
2017
Teaching
eviden
ceJournalo
fProfessional
USA
Qualitative
Nursing
stud
ents
Agrou
pprojectde
sign
edin
Nursing
faculty
isrespon
sibleforprep
aring
Larsen et al. BMC Medical Education (2019) 19:259 Page 16 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
basedpracticeto
unde
rgradu
atenu
rsing
stud
ents
Nursing
aNursing
Research
Metho
dscourse.The
projectwas
basedon
ahypo
thetical
clinicalscen
ario
andstud
ents
wereno
taskedto
implem
entthebe
stinterven
tion
stud
entsto
bereadyforEBP
implem
entatio
n.Creativeanden
joyable
teaching
strategies
aresomewaysto
enhancestud
ents’kno
wledg
eand
compe
tencyof
EBPim
plem
entatio
nin
practice
Smith
-Ston
er[92]
2011
Develop
ingne
wwriters:
answ
eringthecallfor
stud
entmanuscripts
Dim
ension
sof
CriticalCare
Nursing
USA
Qualitative
Nursing
stud
ents
Stud
entsparticipated
ina
critical-carerotatio
nand
wereen
rolledin
anintrod
uc-
tory
research
class
Duringarecent
critical-carenu
rsingrotatio
n,nu
rsingstud
entslearne
dabou
tEBPthroug
hiden
tifying
apo
licythat
need
edrevision
orcreatio
n.By
integratingclinicalissues
into
anintrod
uctio
nto
research
andissues
and
tren
ds,the
stud
entswereableto
answ
era
callforstud
entabstracts.
Smith
-Strøm
[93]
2012
Culture
crashregarding
nursingstud
ents’
expe
rienceof
implem
entatio
nof
EBP
inclinicalpractice
NordicJournalo
fNursing
Research
Norway
Qualitative
Nursing
stud
ents
12daycourse
inEBPstep
s+
collabo
ratio
nwith
clinical
practiceto
applythestep
sof
EBP
Thestud
entswereableto
implem
entEBP
accordingto
thego
alsof
thesyllabu
s,bu
ten
coun
teredaclinicalsettingthat
was
insufficien
tlyprep
ared
,bothstructurallyand
interm
sof
know
ledg
e,to
men
torthem
regardingEBP.
Stom
baug
h[94]
2013
Using
lesson
stud
yto
integrateinform
ation
literacythroug
hout
the
curriculum
Nurse
Educator,2013,
Canada
Canada
Qualitative
Nursing
stud
ents
Lesson
stud
yThelesson
stud
ymetho
disan
idealw
ayto
implem
entascaffoldingapproach
ofteaching
inform
ationliteracyskillstowards
EBPou
tcom
es.
Strickland
[95]
2012
Theuseof
podcaststo
enhanceresearch-
teaching
linkage
sin
unde
rgradu
atenu
rsing
stud
ents
Nurse
Educationin
Practice
Scotland
Quantitative
Nursing
stud
ents
andstud
ents
from
othe
rhe
althcare
disciplines
Blende
dlearning
approach.
Stud
entsweregivenaccess
toaseriesof
5“guest
speaker”po
dcastsmadeup
ofpresen
tatio
nsand
interviewswith
research
expe
rts
Podcastin
goffersnu
rseed
ucatorstheability
toem
bedadditio
nalcon
tent
from
researchersor
clinicians
tohe
lpstud
ents
makelinks
betw
eentheirtheo
reticallearning
andpractice.
Sukkarieh-
Haraty[96]
2017
IntegratingEviden
ce-
BasedPracticeinto
aLebane
seNursing
Bacca-
laureate
Prog
ram:C
hal-
leng
esandSuccesses
InternationalJou
rnalof
Nursing
Education
Scho
larship
Libano
nQualitative
Nursing
stud
ents
Twocoursesat
twodifferent
levels.Stude
ntsused
PICO
clinicalqu
estio
n,ob
served
aselected
clinicalskilland
comparedtheirob
servations
toho
spitalp
rotocoland
againstthelatesteviden
ce-
basedpracticegu
idelines.A
tthesecond
course
stud
ents
prop
osed
change
sin
practice
with
scho
larly
literature.
Anoverallexperienceof
integratingEBP
projectinto
thecurriculum
isfru
itful
for
stud
ents,clinicalagen
cies,and
faculty.
Stud
entsgain
real-life
skillsne
eded
forEBP.
Whalen[97]
2015
Teaching
System
atic
Searchingin
aBaccalaureateNursing
Research
Cou
rse
World
view
son
Eviden
ce-
basedNursing
USA
Quantitative
Nursing
stud
ents
Implem
entin
gsystem
atic
workshe
etsandresearch
logs
onstud
ents’EBP
projects
Stud
entswho
didno
tusesystem
aticsearch
workshe
etsandresearch
logs
scored
sign
ificantlylower
oneviden
cesummaries
than
stud
entsusingsystem
aticsearch
workshe
etsandresearch
logs.
Larsen et al. BMC Medical Education (2019) 19:259 Page 17 of 33
Table
2Stud
ycharacteristics(N
=81)(Con
tinued)
Firstauthor
Year
Title
Journal
Cou
ntry
Design
Participants
Metho
dsforteaching
EBP
Mainstud
yfinding
s
Won
der[98]
2015
Activelearning
strategies
toteach
unde
rgradu
atenu
rsing
statistics:Con
necting
classandclinicalto
prep
arestud
entsforEBP
Worldview
son
eviden
ce-
basednu
rsing
USA
Quantitative
Nursing
stud
ents
Activelearning
strategy:Stude
ntsare
presen
tedwith
acase
scen
ario
viaPo
werPo
intto
starttheactivelearning
expe
rience.Sm
allg
roup
s/each
person
collectsdata
individu
ally(cho
colate
chip
cookies,exercise).
Metho
dologicaland
statisticaldiscussion
s
Theactivelearning
exercisesand
assign
men
tshadapo
sitiveim
pact
onstud
ents’acade
micandclinical
developm
ent.Stud
entsrepo
rted
that
bybe
ginn
ingwith
simpleexercisesthat
allowed
them
tovisualiseandph
ysicallytouchdata,
iten
abledthem
toprog
ress
tomoreabstract
andcomplex
applications.
Yu[99]
2013
Improvem
entin
critical
thinking
disposition
sof
unde
rgradu
atenu
rsing
stud
entsthroug
hprob
lem-based
learning
:acrossover-expe
rimen
tal
stud
y
Journalo
fNursing
Education
China
Quantitative
Nursing
stud
ents
One
grou
preceiving
prob
lem-based
learning
(PBL)
andtheothe
rgrou
preceiv-
inglecture-basedlearning
(LBL)as
acontrol
PBLisan
effectivemetho
dto
improvethe
quality
ofmed
icalteaching
andtheabilities
ofnu
rsingstud
ents,aswellasameans
toim
proveim
plem
entatio
nof
know
ledg
e,ability,and
quality,b
utitalso
presen
tsan
effectivemeans
toim
provecriticalthinking
disposition
sin
nursingstud
entsin
China.
Zhang[100]
2012
Assistin
gun
dergradu
ate
nursingstud
entsto
learneviden
ce-based
practicethroug
hself-
directed
learning
and
worksho
pstrategies
dur-
ingclinicalpracticum
Nurse
EducationToday
China
Quantitative
Nursing
stud
ents
Apilotlearning
prog
ramme
includ
ingaself-directed
learning
processforEBPba-
sics
andaworksho
pforcrit-
icalappraisalo
fliterature
Sign
ificant
improvem
entin
stud
ents’
percep
tionof
EBPknow
ledg
e,attitud
es,
beliefs,and
behaviou
r.Stud
entsfoun
dthe
prog
rammehe
lpfulinprom
otingtheir
analyticalandprob
lem-solving
abilities.
Larsen et al. BMC Medical Education (2019) 19:259 Page 18 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
Balakas,
2010
[23]
Research
coursesand
worksho
ps
Stud
entslearne
dho
wto
usetheirclinicalPICO
questio
n…
..asagu
ideforcond
uctin
gliteraturesearches
Stud
entsweregu
ided
inthe
useof
rapidappraisal
guidelines
forqu
antitative
andqu
alitativeresearch.
Writtencriticalapp
raisals
werecompleted
tofurthe
rde
velopstud
ents’critiquing
skills
Each
stud
entgrou
ppresen
tedtheirPICO
questio
ns,evide
ncesynthe
sis,
referencelist,and
recommen
datio
nsto
the
commun
ityprog
ramme
managers
Stud
entslearne
dto
evaluate
abo
dyof
eviden
ceClassroom
+clinical
practice
Bloo
m,2013
[26]
Research
coursesand
worksho
ps
Nursing
ScienceI:Theprocess
ofreview
ingtheliteratureis
explored
,and
thefinalproject
forthecourse
isaliterature
search
design
edto
iden
tify
themostcurren
teviden
ceavailableforagiventopic
Nursing
ScienceII:The
emph
asisof
thecourse
ison
criticalapp
raisalof
aprim
ary
research
repo
rt
Nursing
ScienceIII:Stude
nts
useeviden
ce-based
mod
els
tosystem
aticallypractice
decision
-makingskillsrelated
toaclinicalqu
estio
nof
inter-
estto
them
Classroom
Boyd,2015
[27]
Research
coursesand
worksho
ps
Classroom
Cable-
Williams,
2014
[29]
Research
coursesand
worksho
ps
Classroom
+clinical
practice
Davidson,
2016
[33]
Research
coursesand
worksho
ps
Stud
entslearnto
develop
PICOclinicalqu
estio
ns…
…searches
forexternal
eviden
ceto
answ
erfocused
clinicalqu
estio
ns…
…participates
inthecritical
appraisalo
fpu
blishe
dresearch
stud
ies…
…to
determ
inetheir
streng
thandapplicability
toclinicalpractice…
…anddissem
inates
best
practices
supp
ortedby
eviden
ceto
improvequ
ality
ofcare
andpatient
outcom
es
Classroom
Dew
ar,2012
[35]
Research
coursesand
worksho
ps
Four
3-hwritingworksho
psinclud
ingho
wto
developa
clinicalqu
estio
n…
…andiden
tifyrelevant
inform
ationfro
mpu
blishe
dresearchstud
ies
Classroom
Friberg,
2013
[42]
Research
coursesand
worksho
ps
Stud
entshadaclose
collabo
ratio
nwith
librarians
with
tendifferent
worksho
psfocusing
ondifferent
aspe
cts
ofliteratureretrieval
Stud
entsused
know
ledg
e-basedanalysisof
both
quan-
titativeandqu
alitative
results…
…andbe
steviden
cefora
specificnu
rsingactio
nand
transformed
results
andne
wknow
ledg
einto
practice
Classroom
Jakube
c,2013
[47]
Research
coursesand
worksho
ps
Stud
entswrote
their
appraisalo
feviden
cein
anexistin
gpo
licyor
guideline…
…met
with
ahe
alth
referencelibrarianto
cond
uct
asystem
aticsearch
ofthe
literatureon
thetopic…
…provided
acriticalreview
ofexistin
geviden
cewith
thepo
licyor
guidelineand
review
edanyup
datedor
morerecent
eviden
ce…
…andwrote
asummaryof
theirrecommen
dedpo
licy
change
sforpractice
Classroom
Jalali-Nia,
2011
[48]
Research
coursesand
Theeviden
ce-based
ap-
proach,learningactivities
…searchingforeviden
ce…
…readingandcritiqu
ing
nursingresearch…
…anddiscussing
articles,
synthe
sising
theeviden
ce,
Classroom
Larsen et al. BMC Medical Education (2019) 19:259 Page 19 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
worksho
psforeach
grou
pinclud
edde
-veloping
aclinicalqu
estio
nusingthePICO
…
andde
veloping
asummary
offinding
s
Janke,2012
[49]
Research
coursesand
worksho
ps
Stud
entshadto
clarify
the
research
questio
n……de
sign
ingaliterature
search
strategy
andcomplete
thesearch…
…select
thearticlesand
record
impo
rtantdata
from
thearticles…
…andsubm
itthepape
r/results
totheclinicalpartne
rsClassroom
Jelsne
ss-
Jørgen
sen,
2015
[50]
Research
coursesand
worksho
ps
Week1:Lectures
indatabases
andliteraturesearch
Week1:Introd
uctio
nto
CriticalApp
raisalSkillTools.
Week2:Group
workand
seminarsfocusing
oncritical
appraisalo
fqu
alitative
pape
rs.W
eek3:Group
work
andseminarsfocusing
oncriticalapp
raisalof
quantitativepape
rs
Classroom
Jone
s,2011
[52]
Research
coursesand
worksho
ps
Theassessmen
ttaskswere
design
edto
enablestud
ents
tocond
uctandrepo
rta
critiqu
eof
apu
blishe
dpape
r
Thethird
andfourth
assessmen
ttaskswere
design
edto
enablestud
ents
toapplytheskillsthey
had
learnt
inthesubject
Classroom
Kiekkas,
2015
[54]
Research
coursesand
worksho
ps
Classroom
Kyriakoulis,
2016
[10]
Research
coursesand
worksho
ps
Interven
tions
covered
different
step
sof
theEBP
domains:Research
questio
n…
…sourcesof
eviden
ce…2
stud
iesfocusedon
the
searchingdatabasesskill
…eviden
ceappraisal…
…andim
plem
entatio
ninto
practice…
Classroom
Leach,2016
[55]
Research
coursesand
worksho
ps
Iden
tificationand
developm
entof
research
questio
nfro
mpractice
Con
structionandexecution
ofsearch
strategies
toretrieve
relevant
prim
aryresearch
articles
Criticalappraisalo
fthe
literature
Summary,presen
tatio
nand
dissem
inationof
eviden
cein
different
form
ats
Classroom
+clinical
practice
Lewis,2016
[56]
Research
coursesand
worksho
ps
TheEBP1
course
aimed
tode
velopfoun
datio
nknow
ledg
eandskillsin
EBP,
with
emph
asison
threeof
thefiveEBPstep
sou
tline
din
theSicilyStatem
entincl.
Fram
earesearch
questio
n…
…to
access
andsearch
library
databasesandothe
rresourcesandto
reflect
ontheprocessesassociated
with
thisapproach.
TheEBP2
course
had
additio
naltraining
inApp
raisingmetho
dological
bias…
…as
wellasteaching
stud
entsho
wto
applyeach
ofthefive
EBPstep
sClassroom
Liou
,2013
Research
Miniresearchprojectwith
…cond
uctliterature
…read
andselect
articles…
…andan
oralandpo
ster
Classroom
Larsen et al. BMC Medical Education (2019) 19:259 Page 20 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
[57]
coursesand
worksho
psintrod
uctio
nho
wto
form
ulatearesearch
prob
lem…
searches…
presen
tatio
nof
finding
s
Morris,2016
[65]
Research
coursesand
worksho
ps
Classroom
Phillips,2014
[75]
Research
coursesand
worksho
ps
Classroom
Pierce,2016
[76]
Research
coursesand
worksho
ps
Duringthee-po
ster
confer-
ence
stud
entsde
velopare-
search
questio
n…
…appraise
data
collection…
…critiqu
epu
blishe
dliterature…
…andwriteabou
tho
wto
beginachange
toorganisatio
nalvisitatio
npo
licybasedon
theresearch
eviden
cefro
mthepo
ster
conferen
ce
Classroom
Rodriguez,
2012
[83]
Research
coursesand
worksho
ps
Stud
entscond
ucteda
research
projectwhich
includ
edaliteraturereview
…
…presen
tedtheirresults
and
design
edascientificpo
ster
with
theirresults
Classroom
Whalen,
2015
[97]
Research
coursesand
worksho
ps
Theworkshe
etinclud
edmainlystep
1–3of
EBP.
Askingaclinicalqu
estio
nusingPICO
…
…searchingtheliterature…
…andcritically
appraising
theliteraturefoun
dClassroom
Zhang,
2012
[100]
Research
coursesand
worksho
ps
Stud
entsinde
pend
ently
cond
uctedon
lineandlibrary
searches
tofindinform
ation
Stud
entswereaskedto
read
anassign
edarticleand
critiqu
eitto
thebe
stof
theirability
Stud
entscreated
presen
tatio
nslides
and
shared
anin-dep
thcritiqu
eof
oneaspe
ctof
thespecified
research
article
Classroom
+clinical
practice
Milner,2017
[62]
Research
coursesand
worksho
ps
Stud
entslearnto
build
and
framepracticequ
estio
nsby
gaming
Classroom
Sukkarieh-
Haraty,2017
[96]
Research
coursesand
worksho
ps
Stud
entslearne
dho
wto
useaclinicalPICOqu
estio
n…andcollected
scho
larly
literature
Com
paredtheirob
servations
toho
spitalp
rotocolagainst
thelatesteviden
ce-based
practicegu
idelines
Stud
entsprop
osed
change
sin
practicewith
scho
larly
literature
Classroom
+clinical
practice
Erichsen
,2018
[40]
Research
coursesand
worksho
ps
Ask
aclinicalqu
estio
nCollect
relevant
literature/
articles
Criticallyappraise
thearticles
Stud
entspresen
ttheirwork
indifferent
ways;e.g.
implem
entatio
n-plan,p
oster
Theresults
wereevaluated
Classroom
+clinical
practice
Scurlock-
Evans,2017
Research
coursesand
Stud
entsweretaug
htwhat
EBPis,h
owitlinks
with
Stud
entsweretaug
htho
wto
assess
quality
ofStud
entsun
dertoo
kan
inde
pend
entresearch
project
Classroom
Larsen et al. BMC Medical Education (2019) 19:259 Page 21 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
[90]
worksho
psresearch
metho
dology
and
processandethics
(inyear
2)literature/eviden
ce(in
year
1)in
theirfinalyear
(3year)
Keiffer,2018
[53]
Research
coursesand
worksho
ps
Stud
entsaskaPICO
T(pop
ulation,interven
tion,
control,ou
tcom
es,tim
e)qu
estio
n
Develop
strategies
tosearch
–andsearch
App
raiseresearch
Designachange
and
dissem
inatetheeviden
ceby
makingrecommen
datio
nsfor
bestpractice
Classroom
Sin,2017
[91]
Research
coursesand
worksho
ps
Faculty
have
framed
questio
ns/stude
ntsde
velop
aqu
estio
nusingPICO
later
intheirnu
rsingscho
ol
Acquirin
geviden
ceby
selectingeviden
ce-based
re-
sourcesthroug
hliteraturein
collabo
ratio
nwith
alibrarian
Stud
entsstatetheratio
nale
fortheirinterven
tionchoice
incorporatingtheappraisal
learne
din
theclass
Stud
entsareaskedto
iden
tify
atleastthreeEBP
implem
entatio
nstrategies
basedon
theirliterature
review
usingat
leasttw
oreferences
Classroom
Coyne
,2018
[31]
Research
coursesand
worksho
ps
Stud
entslearne
dho
wto
askresearch
questio
nsand
how
tolean
onon
eanothe
rforhe
lpand
guidance
Stud
entshe
lped
thefaculty
mem
berin
herresearch
projectto
collect
relevant
literature
…includ
inghe
lpingwith
initialreview
oftheliterature
Stud
entsdidaform
alpo
dium
presen
tatio
nregardingtheirsummer
expe
riences.The
prog
ramme
ledto
change
sat
thehe
alth
system
andledto
initiation
ofresearch
stud
ies
Classroom
+clinical
practice
Hande
,2017
[44]
Research
coursesand
worksho
ps
Stud
entsiden
tifythe
potentialclinicalqu
estio
nsas
they
becomeaw
areof
curren
tge
neralistnu
rsing
care
prob
lems
Stud
entsaregu
ided
throug
hthesequ
ence
ofstep
sto
review
research
Stud
entscritically
appraise
thescho
larly
inform
ation
Stud
entsaregu
ided
throug
hthesequ
ence
ofstep
sto
developan
EBP
implem
entatio
nplan
Stud
entsmakeapresen
tatio
nof
aneviden
ce-based
project
addressing
aselected
clinical
prob
lem
forthepu
rposes
ofim
provingclinicalou
tcom
es:
Popu
latio
n/patient,p
roblem
,interven
tion,comparison
,out-
come,tim
equ
estio
n,recom-
men
datio
nsforeviden
ce-
basedpracticechange
Classroom
+clinical
practice
MalikG,
2017
[59]
Research
coursesand
worksho
ps
Askingclinicalqu
estio
nsFind
ingrelevant
eviden
ce(som
etim
esworksho
psde
livered
bythelibrary
staff)
App
raisingtheeviden
ceApp
lyingeviden
ceinto
clinicalpractice(the
oretically)
Classroom
Berven
,2010
[24]
Collabo
ratio
nwith
clinical
practice
Clinical
practice
ElsborgFoss,
2014
[38]
Collabo
ratio
nwith
clinical
practice
Stud
entsweretaug
htin
compu
ter-basedliterature
search
Stud
entsread,app
raised
,anddiscussedthearticles
that
werechosen
Stud
entspresen
tedthe
finding
sfro
mtheliterature
search
abou
t‘bestpractice’
andtherecommen
datio
nsforchange
s…
…andsecond
-yearstud
ents
observed
towhatextent
the
decision
sabou
tchange
swere
followed
Classroom
Larsen et al. BMC Medical Education (2019) 19:259 Page 22 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
Gray,2010
[43]
Collabo
ratio
nwith
clinical
practice
Intheintrod
uctory
nursingresearch
course
priorto
theresearch
partne
rship,
alln
ursing
stud
entsarerequ
iredto
completean
eviden
ce-based
research
projectinclud
ingthefivestep
sClassroom
+clinical
practice
Moch,2010
[64]
Collabo
ratio
nwith
clinical
practice
Classroom
Moch,2010
[63]
Collabo
ratio
nwith
clinical
practice
Indiscussion
grou
psstud
ents
foun
dfour
articlesrelatedto
thetopic…
…andstud
entsandstaff,
alon
gwith
faculty,readand
discussedeach
ofthe
articlesin
four
discussion
sessions
Classroom
Ode
ll&
Barta,2011
[71]
Collabo
ratio
nwith
clinical
practice
Assignm
entou
tcom
esrelatedto
step
2and3:Collabo
rate
inthecollectionof
eviden
ceandparticipatein
theprocessof
appraisal,of
eviden
ce
Clinical
practice
O’Neal,2016
[70]
Collabo
ratio
nwith
clinical
practice
Stud
entswrote
arelated
PICOTqu
estio
n……cond
uctedareview
ofthe
literature
…followed
guidelines
tocritically
appraise
articles
…iden
tifiedapplicationto
practice
…de
velope
drecommen
datio
nforthe
future
Clinical
practice
Penn
ington
,2010
[73]
Collabo
ratio
nwith
clinical
practice
Stud
entswrote
upthe
form
alised
research
prop
osal
Stud
entspe
rform
edliterature
searches
and…
…wereinstrumen
tsin
collectionandanalysisof
thepre-im
plem
entatio
nsur-
veydata
Thepartne
rships
offered
stud
ents+staffan
oppo
rtun
ityto
expe
rience
how
makebe
stpractice
decision
susingasystem
atic
EBPprocess
Classroom
+clinical
practice
Raines,2016
[78]
Collabo
ratio
nwith
clinical
practice
Stud
entssearched
relevant
eviden
ceand…
…review
edtheliterature
foun
dandappraisedthe
quality
oftheeviden
cefoun
d
Classroom
+clinical
practice
Reiche
rter,
2013
[80]
Collabo
ratio
nwith
clinical
practice
Stud
entslearnto
develop
aneviden
ce-based
questio
n…
…search
forandretrieve
relevant
journalarticles…
…analysetheresults…
…stud
entteam
screate
and
presen
tacase
repo
rtto
classm
ates
andou
tline
potentialclinicalde
cision
susingtheeviden
ce
Classroom
+clinical
practice
Schams,
2012
[87]
Collabo
ratio
nwith
clinical
practice
Stud
entswereen
couraged
towriteaclinicalqu
estio
nusingPICO
T.
Thegrou
pwas
divide
dinto
team
swho
shared
therespon
sibilitiesforsearchingand
repo
rtingEBPinform
ationthat
supp
ortedor
refutedcurren
tpractice.Asateam
stud
ents
discussedrelatio
nships
amon
glabo
ratory
concep
ts,current
practice,andEBPinform
ation
foun
din
literature.By
usingpo
st-con
ferencetim
eim
med
iatelyfollowingclinicalpracticeex-
periences,stude
ntscouldassociatetheirpe
rson
alexpe
riences
inpracticewith
theEBP
inform
ation.
Classroom
+clinical
practice
Scott,2011
[89]
Collabo
ratio
nwith
clinical
Stud
entslearne
dto
write
PICOTqu
estio
ns…
…andsearch
theliterature
Stud
entslearne
dappraisal
andmet
with
therapiststo
…andrelevanceof
eviden
ceto
practice
Classroom
+clinical
Larsen et al. BMC Medical Education (2019) 19:259 Page 23 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
practice
validatedirectionof
search…
practice
Smith
-Ston
er,2011
[92]
Collabo
ratio
nwith
clinical
practice
Stud
entspe
rform
edliterature
searches…
…andpresen
teded
iting
policyto
clinicalstaff
Clinical
practice
Smith
-Strøm,2012
[93]
Collabo
ratio
nwith
clinical
practice
The12
–day
course
traine
dthestud
entsin
thefour
step
sof
EBP:Form
ulatinga
questio
n…
…searchingforeviden
ce…
…critically
appraising
the
eviden
ce…
…andapplying
theeviden
ceClinical
practice
Brow
n,2015
[28]
ITTechno
logy
TheiPad
provided
point-of-
care
access
toclinicalgu
ide-
lines
andresources…
…en
ablingstud
entsto
implem
entan
eviden
ce-
basedapproach
tode
cision
makingandprob
lem
solving
Classroom
Callagh
an,
2011
[30]
ITtechno
logy
Staffrevealed
twokey
research
processesas
being
vitaltostud
ents’
unde
rstand
ingof
research
andsubseq
uent
critical
appraisal,thesebe
ing
searchingfor…
…andevaluatin
gliterature
Classroom
Doyle,2016
[36]
ITtechno
logy
Mob
ilesoftwareisapo
sitive
inform
ationtool
for
inform
ationliteracy…
…andforinform
ingclinical
decision
sClinical
practice
Eales-
Reynolds,
2012
[37]
ITtechno
logy
Stud
entsindicatedthat
the
WRA
Pim
proved
theircritical
appraisalskills…
…andqu
estio
ning
ofthe
research
eviden
cebasisfor
practice
Classroom
Morris,2010
[66]
ITtechno
logy
Thegu
idelineappraisal
activity
helped
stud
ents
form
ulated
asearchable
questio
n
Thegu
idelineappraisal
activity
helped
stud
ents
retrieve
eviden
ce
Thegu
idelineappraisal
activity
helped
stud
ents
critically
appraise
the
eviden
ce
Thegu
idelineappraisal
activity
helped
stud
ents
applytheeviden
ceto
practice
Clinical
practice
Nadelson,
2014
[68]
ITtechno
logy
Criticalgrou
pappraisalsof
EBPweb
sitesrelevant
for
clinicians
Classroom
Revaitis,
2013
[81]
ITtechno
logy
Throug
hFaceTime
vide
ocon
ferencestud
ents
bene
fitfro
minteractingwith
research
team
sandareable
todiscussho
wresearch
finding
sareappliedto
practice
Classroom
Larsen et al. BMC Medical Education (2019) 19:259 Page 24 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
Strickland,
2012
[95]
ITtechno
logy
Classroom
Blazeck,
2011
[25]
Assignm
ents
Themainpu
rposeof
the
assign
men
tisaccessing
research-based
eviden
cerele-
vant
toan
iden
tifiedclinical
prob
lem
Classroom
Daw
ley,
2011
[34]
Assignm
ents
Stud
entswereto
gene
rate
relevant
clinicalqu
estio
nsthat
evolvedfro
mtheir
clinicalexpe
riences…
…andwereaskedto
cond
uct
aliteraturesearch
toiden
tify
tworesearch
articlesthat
beganto
answ
ertheir
questio
ns
Classroom
McCurry,
2010
[61]
Assignm
ents
Stud
entscompleted
adatabase
search
andmet
with
thecourse
faculty
torefineelectron
icsearches…
…critically
exam
ined
the
literature…
…andsubm
itted
abstracts
andprep
ared
anoral
presen
tatio
nandpo
ster
ofthechosen
articles
Classroom
Nadelson,
2014
[67]
Assignm
ents
Stud
entsreceivean
article
tobe
review
ed,readand
critically
appraise
usingthe
CASP
tool
Classroom
Robe
rts,
2011
[82]
Assignm
ents
Stud
entslearne
dto
search
theliteratureusingavariety
ofmechanism
s
Classroom
And
re,2016
[22]
Participationin
research
projects
Increasedun
derstand
ingof
theim
portance
ofcritical
thinking
Increasedun
derstand
ingof
theim
portance
ofim
plem
entatio
nof
research
indaily
practice
Increasedun
derstand
ingof
theim
portance
ofevaluatio
nof
clinicalpracticethroug
htheuseof
EBP
Classroom
+clinical
practice
Hen
och,
2014
[45]
Participationin
research
projects
Stud
entscollected
data
Classroom
+clinical
practice
Niven
,2013
[69]
Participationin
research
projects
Stud
entscollected
both
qualitativeandqu
antitative
data
usingqu
estio
nnaires
Classroom
+clinical
practice
Ruskjer,
2010
[85]
Participationin
research
projects
Faculty
guidetheteam
inconstructin
gthequ
estio
nin
PICO
Librarianprovides
guidance
inthecompu
terlabo
ratory,as
stud
entsgain
hand
s-on
ex-
periencecond
uctin
gan
on-
lineliteraturesearch
Theteam
critically
appraises
system
aticreview
sand
practicegu
idelines,and
individu
alstud
entsappraise
relevant
research
articles
Faculty
assiststheteam
inlookingat
theeviden
ceand
discussesanyrecommen
ded
change
sin
practice
Classroom
Schreine
r,Participationin
Stud
entsinitiated
theproject
Articleswerechosen
byClinical
Larsen et al. BMC Medical Education (2019) 19:259 Page 25 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
2015
[88]
research
projects
bycond
uctin
galiterature
review
forEBParticlesrelated
tohe
artfailure
education
theirrelevanceto
the
enhancem
entof
staff
educationforhe
artfailure
patients
practice
Laaksone
n,2013
[58]
Journalclubs
Stud
entssearched
for
scientificknow
ledg
eto
answ
eraclinicalqu
estio
nof
thejournalclub…
…evaluatedthearticlesand
othe
rrelevant
material…
…andprep
ared
shortwritten
pape
rsbasedon
the
know
ledg
ethey
had
collected
andevaluated
Classroom
Mattila,2013
[60]
Journalclubs
Stud
entsprep
ared
forthe
journalclubby
acqu
iring
data
with
thehe
lpof
aninform
ationspecialist
After
presen
tingthearticle,
participantsdiscussedho
wtheresults
couldbe
used
innu
rsingcare
andwhattype
ofsolutio
nor
new
perspe
ctivehadbe
engained
.Stud
entsge
neratedthe
discussion
andgave
their
opinionof
thebo
thoraland
written
Classroom
Phelps,2015
[74]
Embe
dded
librarians
TheILCSN
willhe
lpstud
ents
gather…
…analyse…
…anduseinform
ation
Classroom
Putnam
,2011
[77]
Embe
dded
librarians
Theem
bedd
edlibrarian
assisted
stud
entsin
developing
approp
riate
search
techniqu
es
ThesummativeEBPpape
rde
velope
dthereview
ofliterature,includ
ing
integrating,
analysing…
…applying
,and
presen
ting
inform
ation
Classroom
Aglen
,2016
[21]
Theo
riesof
teaching
–and
learning
Thepe
dago
gicalstrateg
iespresen
tedinvite
thelearne
rto
becomean
activeparticipantin
thelearning
activity,e.g.assessing
research,con
ductinga
research
projectandassessingpatients’requ
iremen
tsforhe
althcare.Thismeans
that
they
areen
couraged
tousediscretio
nto
solveill-structuredprob
lems
relatedto
thestep
sof
EBP,theresearch
processandtheirow
nclinicalpractice.Ano
ther
strategy
toen
hancestud
ents’interestandmakethelearning
tasks
relevant
isto
linkthelearning
task
torealclinicalsituations
Classroom
Crawford,
2011
[32]
Theo
riesof
teaching
–and
learning
PBLen
hances
critical
thinking
…..and
transfer
oftheo
ryto
practice
Classroom
+clinical
practice
Epstein,
2011
[39]
Theo
riesof
teaching
–and
learning
Classroom
Florin,2012
[41]
Theo
riesof
teaching
–and
learning
Highe
stcorrelationcoefficientsbe
tweenstud
ents’experienceof
supp
ortforresearch
utilisatio
nandEBPskillsin
form
ulatingqu
estio
nsto
search
for
research-based
know
ledg
e(step1)
andcritically
appraising
andcompilingbe
stknow
ledg
e(step3)
oncampu
s.Classroom
+clinical
practice
Hickm
an,
2014
[46]
Theo
riesof
teaching
–and
learning
Classroom
Larsen et al. BMC Medical Education (2019) 19:259 Page 26 of 33
Table
3Keymetho
dsforteaching
unde
rgradu
atehe
althcare
stud
entsEBP,theSicilyStatem
ent’s
fivestep
sof
teaching
andcond
uctin
gEBPandcontext(Con
tinued)
Source
(first
author,year)
Keymetho
dsforteaching
unde
rgradu
ate
healthcare
stud
entsEBP
TheSicilyStatem
ent’s
fivestep
sin
teaching
andcond
uctin
gEBP
Con
text
1.Ask
aclinicalqu
estio
n2.Collect
themostrelevant
eviden
ce3.Criticallyappraise
the
eviden
ce4.Integratetheeviden
cewith
one’sclinicalexpe
rtise,
patient
preferen
ces,and
values
tomakepractice
decision
5.Evaluate
change
orou
tcom
e
John
son,
2010
[51]
Theo
riesof
teaching
–and
learning
Stud
entsde
veloptheirow
nresearch
prop
osal,w
hich
includ
esde
finingaresearch
questio
n…
…searchingtheliterature…
…andform
ulateapprop
riate
metho
dsClassroom
Oja,2011
[72]
Theo
riesof
teaching
–and
learning
Allstud
iesexcept
onein
the
review
foun
dsign
ificant
effectsof
PBLon
critical
thinking
skills
Clinical
practice
Raurell-
Torred
à,2015
[79]
Theo
riesof
teaching
–and
learning
Classroom
+clinical
practice
Rolloff,2010
[84]
Theo
riesof
teaching
–and
learning
Stud
entswillde
velop
inform
ationliteracyskills…
…exploresystem
aticreview
databasesforeviden
cerelatedto
labo
ratory
expe
riences
andintrod
uce
othe
rinform
ationliteracy
sources
…critiqu
eweb
sites,research
articlesandclinical
expe
riences
from
anEBP
perspe
ctiveforhe
alth
inform
ation
…incorporateEBPinto
patient
care
plansand
developaresearch
prop
osal
basedon
eviden
cegaps
iden
tifiedin
practice
…andevaluate
clinical
policiesandproced
ures
from
anEBPpe
rspe
ctiveand
discusschange
process
Classroom
Ruzafa-
Martin
ez,
2016
[86]
Theo
riesof
teaching
–and
learning
Stud
entsshou
ldiden
tifya
nursingprob
lem
inpatients
caredfordu
ringclinical
training
andform
ulatea
clinicalPICOqu
estio
n...
…iden
tifyclinicalpractice
guidelines,systematicreview
sand/or
originalarticles…
…critically
appraise
search
results…
…de
scrib
erecommen
datio
nson
theclinicalqu
estio
nand
iden
tifythelevelo
feviden
ceandgradeof
recommen
datio
n…
…andpresen
ttheresults
ofthefinalexercise
inapo
ster
totheseminar
grou
p,giving
reason
sforim
plem
entatio
nof
thesearch
results
Classroom
Stom
baug
h,2013
[94]
Theo
riesof
teaching
–and
learning
Soph
omore-level:Stud
entsge
neratedaPICOqu
estio
n…Stud
entscopied
theprocessof
thelibrariande
scrib
ingan
exam
pleof
aPICOqu
estio
n,creatio
nof
asearch
term
and
cond
uctio
nof
asearch
inCINAHL
Junior
level:Stud
entssearched
databasesothe
rthan
CINAHL
Senior
level:Stud
entscreatedPICO
relatedto
practice
expe
rience,individu
allysearched
databasesandretrieved
“bestpractice”
eviden
ce
Classroom
Won
der,
2015
[98]
Theo
riesof
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and ten studies described one step. Twelve studies hadno description of any of the steps.The steps most often referred to were step two, three,
and four. Step two, “Collect the most relevant evidence”,was mentioned in 58 studies. Step three, “Critically ap-praise the evidence”, was referred to in 55 studies, whilestep four, “Integrate the evidence with one’s clinical ex-pertise, patient preferences, and values to make practicedecision”, was mentioned in 51 studies. Step one, “Ask aclinical question”, and step five, “Evaluate change or out-come” was referred to in 36 and 14 studies, respectively.Seven out of the eleven studies referring to all of the SicilyStatement’s five steps were identified under the keymethods “Research courses and workshops” and “Collab-oration with clinical practice”.The context in which the studies were conducted was pri-
marily classroom settings (n = 52). Twenty studies describedcontext as a combination of classroom and clinical practice,and nine studies were conducted in clinical practice.Out of the 68 studies which included the seven key
methods, 24 out of 32 “Research courses and work-shops” were conducted in classrooms, while “Collabor-ation with clinical practice” was conducted in acombination of classroom and clinical practice (n = 6),clinical practice (n = 5), or classrooms (n = 3). “IT tech-nology” was used in classrooms (n = 6) or clinical prac-tice (n = 2). “Assignments” were conducted in classroomsettings only (n = 5), while “Participation in researchprojects” took place in a combination of classroom andclinical practice (n = 3), classroom (n = 1) or clinicalpractice (n = 1). “Embedded librarians” (n = 2) and “Jour-nal clubs” (n = 2) both took place in classroom settings.
DiscussionThis study provides an overview of existing EBP teach-ing methods including The Sicily Statement’s steps ofteaching and conducting EBP with respect to under-graduate healthcare students both in classrooms and inclinical practice.It is beyond the scope of this review to interpret all
the findings of the included studies. The findings dis-cussed below are the key methods most frequently iden-tified in the thematic analysis: “Research courses andworkshops” and “Collaboration with clinical practice”, aswell as the key methods most positively referred to inmain findings of the studies: “IT technology”, “Embed-ded librarians”, and “Journal clubs”. Despite the scarceuse of the last three methods (“IT technology”, “Embed-ded librarians”, “Journal clubs”) these can however pro-vide ideas for how to teach EBP in the future.Furthermore, the scoping review provides useful infor-mation as to which of the Sicily Statement’s five steps ofteaching and conducting EBP are taught in the variousmethods and whether one particular method is more
useful and applicable than others in a particular learningsetting, depending on the context and the learning out-comes. Lecturers, senior lecturers and others who teachEBP at undergraduate healthcare educational institutionscan benefit from this information and gain inspirationand ideas for teaching EBP. We are aware that otherstudies have addressed issues such as teachers’ compe-tencies required for teaching EBP, which we do considerimportant in order to standardise and improve educationin EPB. Interestingly, a study has identified specific setsof EBP core competencies for teachers, which are classi-fied within the 5-step model of EBP [101]. However,since our primary focus was on methods for teachingEBP to undergraduate healthcare students the aspect ofteacher’s competencies has not been further investigated.Overall, the first 4 steps of the Sicily Statement could
more easily be identified. However the last and fifth stepproved to be more difficult to identify which often is thecase. Furthermore, our results tend to point to the factthat the fifth step is often more theoretically linked atthe undergraduate level and that a more specifiedimplemtation and evaluation of the EBP process takesplace at a more advanced level.
Research courses and workshopsResearch courses and workshops were the most fre-quently used methods for teaching EBP. The frequentuse of this method is in agreement with the systematicreview by Kyriakoulis et al., where eight of the 20methods for teaching EBP were research courses, work-shops or similar sessions [10] and Young et al., wherethree out of five methods used for teaching evidence-based healthcare (EBHC) were workshops [2]. The ma-jority of the studies concerning “Research courses andworkshops”, referred to three or more of the Sicily State-ment’s five steps of teaching and conducting EBP [10,23, 26, 31, 33, 40, 42, 44, 47–49, 53, 55–57, 59, 76, 90,91, 96, 97, 100]. Despite the fact that the fifth step wasincluded in some studies, it was not clear what was cov-ered by the evaluation process, and additionally, if it waspart of the students’ assignment work alone or if therewas a link to clinical practice. The majority of the re-search courses and workshops were conducted in class-rooms. According to Young et al., EBHC courses canimprove appraisal skills in nurses, occupational thera-pists and physiotherapists, among others [2]. However,further assessments and analyses of the courses andworkshops found in this scoping review must be madeto ensure that the content and outcomes are applicablein similar contexts.
Collaboration with clinical practiceIn this scoping review, the key method for teaching EBP,“Collaboration with clinical practice” was identified 14
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times in the thematic analysis. In comparison, “collabor-ation with clinical practice” is only mentioned once as amethod for teaching EBP in the review by Young et al.[2] and not mentioned in the systematic review by Kyria-koulis et al. [10]. The results of this scoping review sug-gest that collaboration with clinical practice is afrequently used method for teaching EBP with respect toundergraduate healthcare students. The rare use of thismethod in the review by Kyriakoulis et al. and the reviewby Young et al. might be explained by the type of partici-pants included in these reviews. Only two studies in-cluded undergraduate students in the disciplines ofnursing, physiotherapy or occupational therapy: in thereview by Young et al. and the review by Kyriakoulis [2,10]. Along this line, a review on teaching EBM to med-ical students found weak and inconsistent results from alimited number of studies on the effect of clinically inte-grated methods on knowledge, attitudes, and skills [102].Collaboration with clinical practice might be more fun-damental among undergraduate students in the disci-plines of nursing, physiotherapy or occupational therapy,compared to undergraduate students in medicine pri-marily included in the other reviews [2, 10].Half of the studies identified in relation to “Collabor-
ation with clinical practice”, referred to four or five ofthe Sicily Statement’s steps [38, 43, 70, 73, 80, 87, 89,93]. In two of the studies, the steps were taught directlyin clinical practice as part of the students’ clinical educa-tion [70, 93], and unlike the research courses and work-shops methods, the last step of evaluation of change oroutcome is carried out either partly or entirely in a clin-ical context. The main findings of all eight studies in-dicate that collaboration with clinical practice is aneffective way of teaching EBP, both with the combin-ation of classrooms and clinical practice settings andin clinical practice settings alone. Despite being a rec-ommended strategy in the literature, a recent litera-ture review points to the fact that EBP teachingstrategies including clinical activities in nursing stu-dents seems less prioritised [12].
IT technologyThe key method, “IT technology”, described tools, suchas mobile devices, video resources and websites, amongothers, used in classrooms or clinical practice for seekinginformation in relation to EBP. In clinical practice, mo-bile devices were used to seek information regardingEBP search strategies, critical appraisal of clinical guide-lines [66], and specific task-oriented information in rela-tion to clinical practice [36]. Despite the reportedimprovement in knowledge and skills in relation to EBPand appraisal of clinical guidelines, the use of mobile de-vices was reported as low [66]. In classrooms, the use ofIT technology as a method for teaching EBP was
reported as mainly positive. Today, most students haveaccess to IT equipment and this technology could be in-tegrated in classrooms and clinical practice to seek infor-mation regarding EBP. In the review by Kyriakoulis et al.the results support our findings; that IT technology canbe an effective method for teaching EBP with respect toundergraduate healthcare students [10].
Journal clubs“Journal Clubs” as a method for teaching EBP was onlydescribed in two studies in this scoping review. However,the findings indicated that the method improved stu-dents’ skills in reading articles and understandingevidence-based nursing [60], and promoted competen-ceis needed to deliver evidence-based care [58]. Thestudies included two and three steps, respectively, pro-posed by the Sicily Statement [3]. Additional steps mayadvantageously be incorporated into future journal clubsto ensure the quality of healthcare. Young et al. referredto four reviews describing a positive effect of journalclubs as a method for teaching EBP [2]. However, noneof the reviews included Professional Bachelor Degreehealthcare students. Further studies must be conductedto assess the effectiveness of journal clubs as a methodfor teaching EBP in Professional Bachelor Degree health-care courses and to study the opportunity of incorporat-ing all of the Sicily Statement’s five steps for teachingand conducting EBP.
Embedded librariansIn two studies librarians were introduced to teach stu-dents information literacy [74, 77]. Librarians are expertsin this field and are able to teach students the skills es-sential to EBP [74]. Librarians can support students inestablishing and managing effective search techniquesand help with reviewing and critiquing the informationfound. Thus, students develop information literacy skillsas required in practice [77]. Research librarians who areembedded as part of a research course for teachingundergraduate healthcare students EBP may be an ef-fective way of ensuring a complete introduction to theSicily Statement’s five steps of teaching and conductingEBP. The first three steps can be taught in classrooms,followed by practical exercises in the last two steps inclinical practice.
Implications for practiceThe majority of the key methods found for teaching EBPwere “Research courses and workshops” and “Collabor-ation with clinical practice”, whereas “Journal Clubs”and “Embedded librarians” were identified only twice.The frequent use of research courses and workshops asmethods for teaching EBP may stem from a tradition ofclassroom lectures and is a relatively manageable way to
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teach EBP. The findings from this scoping study how-ever suggest that other methods for teaching EBP withrespect to undergraduate students exist. Journal clubscould be incorporated as a supplement to classroom lec-tures or as part of collaboration with clinical practice. Li-brarians may advantageously be introduced in researchcourses and workshops. The librarians can help studentsgain control of EBP definitions and concepts, and mastersearch techniques before entering clinical practice. Theeffect of journal clubs and embedded librarians on stu-dents’ EBP competencies should however be investigatedfurther before being incorporated into ProfessionalBachelor’s Degree curricula.EBP education based on the Sicily Statement’s five steps,
demanded both internationally and nationally, implies anintroduction to all of the Sicily Statement’s five steps ofteaching and conducting EBP at undergraduate level [5, 6,9]. At present, the majority of the methods found forteaching EBP only include 2–4 steps. In line with these re-sults, a recent review found that the majority of evaluatedEBP educational interventions are focused on a single step(step 3, critically appraising evidence) of the five steps ofteaching and conducting EBP [103]. This research adds tothe statement that an effort must be made to incorporateall five steps of the Sicily Statement in an educational andcooperative way in order to ensure that undergraduatehealthcare students are qualified to work in an evidence-based manner.We did not review available assessment methods for
evaluation of EBP education interventions or pro-grammes in this study. The additional importance of thisfield and the apparent lack of valid evaluation methodshave been extensively highlighted in other studies andneeds to be taken into account when applying methodsfor teaching EPB [104, 105].
Strengths and limitationsThe scoping review presents an updated overview ofexisting methods for teaching EBP with respect toundergraduate healthcare students, including study spe-cific recommendations for teaching methods to be usedin future curricula. It follows recommended guidelinesfor a priori design requirements and transparent report-ing [13, 16].Limitations are however found in relation to the
search strategy. Our search did not include literaturepublished before 2010 and due to time constraints, alimited number of databases were searched, which en-tails the risk that not all relevant literature was identi-fied. Furthermore, the search terms used identifiedprimarily undergraduate nursing students, despite athorough search for all undergraduate students in thedisciplines of nursing, physiotherapy, occupational ther-apy, radiography, and biomedical laboratory science.
Other search terms might have captured these healthdisciplines to a greater extent. An alternative explanationfor the large occurrence of studies regarding nursingstudents could be that there is a greater publishing trad-ition in this field. However, the methods for teachingEBP can to a certain extent, be introduced to under-graduate students in the other health disciplines.
ConclusionConsistent with our objective, this scoping review has pro-vided an extensive overview of literature describingmethods for teaching EBP regarding undergraduate health-care students. The two key methods most often identifiedwere “Research courses and workshops” and “Collaborationwith clinical practice”. Despite the first method often beingused in this scoping review, as well as in other reviews,fewer of the Sicily Statement’s five steps of teaching andconducting EBP were referred to, and if the fifth step ofevaluation of change or outcome was included, the descrip-tion of content was often unclear.On the contrary, “Collaboration with clinical practice”,
the second most used teaching method, more often re-ferred to four or five steps, making this method an effectiveapproach for teaching EBP while ensuring incorporation ofseveral of the steps. Unlike the Research courses and work-shop methods, the last step of evaluation is carried outpartly or entirely in a clinical context.Overall, our results tend to show that the evaluation
step is often theoretically linked at the undergraduatelevel. Despite the small number of studies describing‘Journal clubs’ and ‘Embedded librarians’, these teachingmethods could advantageously be incorporated in theclassroom context and could ensure a complete intro-duction to all five steps.On the basis of our findings, we argue that future re-
search should focus on identifying methods for teachingEBP that incorporate as many of the Sicily Statement’sfive steps of teaching and conducting EBP as possible.Journal clubs and embedded librarians could be furtherlooked into as methods to support the more establishedmethods for teaching EBP across all undergraduatehealthcare disciplines.
AcknowledgementsThe authors would like to thank research assistants Morten Puck, Martin Mau andSusanne Pommergård for their valuable work in reviewing and editing tables.
Authors’ contributionsAST, HKK, CML contributed in designing the study. AST and AFC conductedthe literature search. AST, HKK and CML screened the titles and abstracts.AST, HKK, CML extracted data from the studies. AST and HKK performed asynthesis of study results. AST, HKK, CML and AFC interpreted the data. CMLand AST drafted the manuscript. All the listed authors have contributed toand approved the final manuscript.
FundingThis project is funded by internal funds granted by Health Sciences ResearchCentre, UCL University College, Odense, Denmark. The funding part had no
Larsen et al. BMC Medical Education (2019) 19:259 Page 30 of 33
role in the design of the study, the collection, analysis and interpretation ofthe data, or in writing the manuscript.
Availability of data and materialsThe data used and analysed during the current scoping review are availablefrom the corresponding author on reasonable request.
Ethics approval and consent to participateNot applicable.
Consent for publicationNot applicable.
Competing interestsThe authors declare that they have no competing interests.
Author details1Health Sciences Research Centre, UCL University College, Niels Bohrs Allé 1,5230 Odense M, Denmark. 2Department of Physiotherapy, UCL UniversityCollege, Niels Bohrs Allé 1, 5230 Odense M, Denmark. 3Research Service, UCLLibrary, UCL University College, Niels Bohrs Allé 1, 5230 Odense M, Denmark.4Research Unit for Musculoskeletal Function and Physiotherapy, Departmentof Sports Science and Clinical Biomechanics, University of Southern Denmark,Campusvej 55, 5230 Odense M, Denmark. 5Department of Clinical Research,University of Southern Denmark, Winsløwparken 19, 5000 Odense, Denmark.
Received: 17 December 2018 Accepted: 23 June 2019
References1. Dizon JM, Grimmer-Somers K, Kumar S. Effectiveness of the tailored
Evidence Based Practice training program for Filipino physical therapists: arandomized controlled trial. BMC Med Educ. 2014;14. https://doi.org/10.1186/1472-6920-14-147.
2. Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teachingevidence-based health care (EBHC)? Overview of systematic reviews. PLoSOne. 2014;9(1):e86706.
3. Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, etal. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5(1):1.
4. Burns HK, Foley SM. Building a foundation for an evidence-based approachto practice: teaching basic concepts to undergraduate freshman students. JProf Nurs. 2005;21(6):351–7.
5. Daly M, DeAngelis T. Teaching evidence-based practice across curricula—anoverview of a professional development course for occupational therapyeducators. Occup Ther Health Care. 2017;31:102–9.
6. Greenhalg T, Howick J, Maskrey N. Evidence-based medicine: a movementin crisis? BMJ. 2014;348:g3725.
7. Styrelsen for Videregående Uddannelser, Uddannelses- ogForskningsministeriet. Direction for the work of single professiondevelopment groups. 2015; Available at: http://www.ft.dk/samling/20151/almdel/ufu/bilag/166/1637938/index.htm. Accessed 17 Aug 2017.
8. Ministry of Higher Education and Science. The Danish higher educationsystem. 2016; Available at: https://ufm.dk/uddannelse/anerkendelse-og-dokumentation/dokumentation/europass/diploma-supplement/standardbeskrivelse-af-higher-education-in-denmark/ds-standardbeskrivelse-pdf. Accessed 7 June 2019.
9. Kristensen H, Nøhr-Jensen L, Stokholm G, Berg P, Borg-Hansen K, PedersenK, et al. Evidence-based practice - Health educations University CollegeLillebaelt - Curiculum revision. 2016;1:2–10.
10. Kyriakoulis K, Patelarou A, Laliotis A, Wan AC, Matalliotakis M, Tsiou C, et al.Educational strategies for teaching evidence-based practice to undergraduatehealth students: systematic review. J Educ Eval Health Prof. 2016;13:34.
11. Ghaffari R, Shapoori S, Binazir MB, Heidari F, Behshid M. Effectiveness ofteaching evidence-based nursing to undergraduate nursing students in Iran:a systematic review. Res Dev Med Educ. 2018;7(1):8–13.
12. Horntvedt MT, Nordsteien A, Fermann T, Severinsson E. Strategies forteaching evidence-based practice in nursing education: a thematic literaturereview. BMC Med Educ. 2018;18(1):172.
13. Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E.Systematic review or scoping review? Guidance for authors when choosing
between a systematic or scoping review approach. BMC Med Res Methodol.2018;18(1):143.
14. Merriam-Webster. Classroom. 2017; Available at: https://www.merriam-webster.com/dictionary/classroom. Accessed 30 Mar 2017.
15. Segen’s Medical Dictionary. Clinical practice. 2011; Available at: http://medical-dictionary.thefreedictionary.com/clinical+practice. Accessed 30 Mar 2017.
16. The Joanna Briggs Institute. The Joanna Briggs Institute reviewer’s manual:2015 edition / supplement. 2015; Available at: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf. Accessed 7 June 2019.
17. Joanna Briggs Institute. JBI reviewer’s manual. 2019; Available at: https://wiki.joannabriggs.org/display/MANUAL. Accessed 7 June 2019.
18. Communiqué of the Conference of European Ministers Responsible forHigher Education. The Bologna Process 2020 - The European highereducation area in the new decade. 2009; Available at: http://www.ehea.info/media.ehea.info/file/2009_Leuven_Louvain-la-Neuve/06/1/Leuven_Louvain-la-Neuve_Communique_April_2009_595061.pdf. Accessed 15 May 2019.
19. Paniagua H. Planning research: methods and ethics. Pract Nurs.2002;13(1):22–5.
20. Cronin P, Ryan F, Coughlan M. Undertaking a literature review: a step-by-step approach. Br J Nurs. 2008;17(1):38–43.
21. Aglen B. Pedagogical strategies to teach bachelor students evidence-basedpractice: a systematic review. Nurse Educ Today. 2016;36:255–63.
22. Andre B, Aune AG, Braend JA. Embedding evidence-based practiceamong nursing undergraduates: results from a pilot study. NurseEduc Pract. 2016;18:30–5.
23. Balakas K, Sparks L. Teaching research and evidence-based practice using aservice-learning approach. J Nurs Educ. 2010;49(12):691–5.
24. Berven L. Students collaborate with nurses from a nursing home to get anevidence based practice...Fourth European Nursing Congress. J Clin Nurs.2010;19:78.
25. Blazeck A, Klem ML, Miller TH. Building evidence-based practice into thefoundations of practice. Nurse Educ. 2011;36(3):124–7.
26. Bloom KC, Olinzock BJ, Radjenovic D, Trice LB. Leveling EBP content forundergraduate nursing students. J Prof Nurs. 2013;29(4):217–24.
27. Boyd MR, Baliko B, Polyakova-Norwood V. Using debates to teach evidence-based practice in large online courses. J Nurs Educ. 2015;54(10):578–82.
28. Brown J, McCrorie P. The iPad: tablet technology to support nursing andmidwifery student learning: an evaluation in practice. Comput Inform Nurs.2015;33(3):93–8.
29. Cable-Williams B, Rush J, Mowry A, Macleod A, Gilmer C, Graham C, et al. Aneducational innovation to foster evidence-informed practice. J Nurs Educ.2014;53(3):S55–8.
30. Callaghan L, Lea SJ, Mutton L, Whittlesea E. Enhancing health students’understanding of generic research concepts using a web-based videoresource. Nurse Educ Pract. 2011;11(6):375–9.
31. Coyne BM, Kennedy C, Self A, Bullock L. A comprehensive approach toundergraduate nursing students’ research experiences. J Nurs Educ.2018;57(1):58–62.
32. Crawford TR. Using problem-based learning in web-based components ofnurse education. Nurse Educ Pract. 2011;11(2):124–30.
33. Davidson SJ, Candy L. Teaching EBP using game-based learning:improving the student experience. Worldviews Evid Based Nurs. 2016;13(4):285–93.
34. Dawley K, Bloch JR, Suplee PD, McKeever A, Scherzer G. Using apedagogical approach to integrate evidence-based teaching in anundergraduate women’s health course. Worldviews Evid Based Nurs.2011;8(2):116–23.
35. Dewar SR. The evidence-based practice course as an opportunity forwriting. Nurse Educ. 2012;37(4):143–4.
36. Doyle GJ, Furlong KE, Secco L. Information literacy in a digital era:understanding the impact of mobile information for undergraduate nursingstudents. Stud Health Technol Inform. 2016;225:297–301.
37. Eales-Reynolds LJ, Gillham D, Grech C, Clarke C, Cornell J. A study of thedevelopment of critical thinking skills using an innovative web 2.0 tool.Nurse Educ Today. 2012;32(7):752–6.
38. Elsborg Foss J, Kvigne K, Wilde Larsson B, Athlin E. A model (CMBP) forcollaboration between university college and nursing practice to promoteresearch utilization in students’ clinical placements: a pilot study. NurseEduc Pract. 2014;14(4):396–402.
39. Epstein I, Santa Mina EE, Gaudet J, Singh MD, Gula T. Teaching statistics toundergraduate nursing students: an integrative review to inform our
Larsen et al. BMC Medical Education (2019) 19:259 Page 31 of 33
pedagogy. Int J Nurs Educ Scholarsh. 2011;8(1). https://doi.org/10.2202/1548-923X.2234.
40. Erichsen T, Røkholt G, Utne I. Kunnskapsbasert praksis isykepleierutdanningen. Sykepleien Forskning. 2018;11(1):66–76.
41. Florin J, Ehrenberg A, Wallin L, Gustavsson P. Educational support for researchutilization and capability beliefs regarding evidence-based practice skills: anational survey of senior nursing students. J Adv Nurs. 2012;68(4):888–97.
42. Friberg F, Lyckhage ED. Changing essay writing in undergraduatenursing education through action research: a Swedish example. NursEduc Perspect. 2013;34(4):226–32.
43. Gray MT. Research odyssey: the evolution of a research partnershipbetween baccalaureate nursing students and practicing nurses. Nurse EducToday. 2010;30(4):376–82.
44. Hande K, Ty Williams C, Robbins HM, Kennedy BB, Christenbery T.Leveling evidence-based practice across the nursing curriculum. J NursePract. 2017;13(1):e17–22.
45. Henoch I, Jakobsson Ung E, Ozanne A, Falk H, Falk K, Kenne Sarenmalm E,et al. Nursing students’ experiences of involvement in clinical research: anexploratory study. Nurse Educ Pract. 2014;14(2):188–94.
46. Hickman LD, Kelly H, Phillips JL. EVITEACH: a study exploring ways tooptimise the uptake of evidence-based practice to undergraduate nurses.Nurse Educ Pract. 2014;14(6):598–604.
47. Jakubec SL, Astle BJ. Students connecting critical appraisal to evidence-based practice: a teaching-learning activity for research literacy. J NursEduc. 2013;52(1):56–8.
48. Jalali-Nia SF, Salsali M, Dehghan-Nayeri N, Ebadi A. Effect of evidence-based education on Iranian nursing students’ knowledge and attitude.Nurs Health Sci. 2011;13(2):221–7.
49. Janke R, Pesut B, Erbacker L. Promoting information literacy throughcollaborative service learning in an undergraduate research course. NurseEduc Today. 2012;32(8):920–3.
50. Jelsness-Jørgensen L. Does a 3-week critical research appraisal course affect howstudents perceive their appraisal skills and the relevance of research for clinicalpractice? A repeated cross-sectional survey. Nurse Educ Today. 2015;35(1):e1–5.
51. Johnson N, List-Ivankovic J, Eboh WO, Ireland J, Adams D, Mowatt E, et al. Researchand evidence based practice: using a blended approach to teaching and learningin undergraduate nurse education. Nurse Educ Pract. 2010;10(1):43–7.
52. Jones SC, Crookes PA, Johnson KM. Teaching critical appraisal skills fornursing research. Nurse Educ Pract. 2011;11(5):327–32.
53. Keiffer MR. Engaging Nursing Students: Integrating Evidence-Based Inquiry,Informatics, and Clinical Practice. Nurs Educ Perspect. 2018;39(4):247-249.
54. Kiekkas P, Panagiotarou A, Malja A, Tahirai D, Zykai R, Bakalis N, et al.Nursing students’ attitudes toward statistics: effect of a biostatisticscourse and association with examination performance. Nurse EducToday. 2015;35(12):1283–8.
55. Leach MJ, Hofmeyer A, Bobridge A. The impact of research education onstudent nurse attitude, skill and uptake of evidence-based practice: adescriptive longitudinal survey. J Clin Nurs. 2016;25(1–2):194–203.
56. Lewis LK, Wong SC, Wiles LK, McEvoy MP. Diminishing effect sizes withrepeated exposure to evidence-based practice training in entry-level healthprofessional students: a longitudinal study. Physiother Can. 2016;68(1):73–80.
57. Liou SR, Cheng CY, Tsai HM, Chang CH. Innovative strategies for teachingnursing research in Taiwan. Nurs Res. 2013;62(5):335–43.
58. Laaksonen C, Paltta H, von Schantz M, Ylönen M, Soini T. Journal club as amethod for nurses and nursing students’ collaborative learning: adescriptive study. Health Sci J. 2013;7(4):285–92.
59. Malik G, McKenna L, Griffiths D. Using pedagogical approaches to influenceevidence-based practice integration - processes and recommendations:findings from a grounded theory study. J Adv Nurs. 2017;73(4):883–93.
60. Mattila L, Rekola L, Koponen L, Eriksson E. Journal club intervention inpromoting evidence-based nursing: perceptions of nursing students. NurseEduc Pract. 2013;13(5):423–8.
61. McCurry MK, Martins DC. Teaching undergraduate nursing research: acomparison of traditional and innovative approaches for success withmillennial learners. J Nurs Educ. 2010;49(5):276–9.
62. Milner KA, Cosme S. The PICO game: an innovative strategy forteaching step 1 in evidence-based practice. Worldviews Evid-BasedNurs. 2017;14(6):514–6.
63. Moch SD, Cronje RJ. Part II. Empowering grassroots evidence-based practice:a curricular model to foster undergraduate student-enabled practicechange. J Prof Nurs. 2010;26(1):14–22.
64. Moch SD, Cronje RJ, Branson J. Part 1. Undergraduate nursing evidence-based practice education: envisioning the role of students. J Prof Nurs.2010;26(1):5–13.
65. Morris J. The use of team-based learning in a second year undergraduatepre-registration nursing course on evidence-informed decision making.Nurse Educ Pract. 2016;21:23–8.
66. Morris J, Maynard V. Pilot study to test the use of a mobile device in theclinical setting to access evidence-based practice resources. WorldviewsEvid-Based Nurs. 2010;7(4):205–13.
67. Nadelson S, Nadelson LS. Evidence-based practice article reviewsusing CASP tools: a method for teaching EBP. Worldviews Evid BasedNurs. 2014;11(5):344–6.
68. Nadelson SG. Online resources: fostering students evidence-based practicelearning through group critical appraisals. Worldviews Evid-Based Nurs.2014;11(2):143–4.
69. Niven E, Roy DE, Schaefer BA, Gasquoine SE, Ward FA. Making research real:embedding a longitudinal study in a taught research course forundergraduate nursing students. Nurse Educ Today. 2013;33(1):64–8.
70. O'Neal PV, McClellan LC, Jarosinski JM. A new model in teachingundergraduate research: a collaborative approach and learningcooperatives. Nurse Educ Pract. 2016;18:80–4.
71. Odell E, Barta K. Teaching evidence-based practice: the bachelor of sciencein nursing essentials at work at the bedside. J Prof Nurs. 2011;27(6):370–7.
72. Oja KJ. Using problem-based learning in the clinical setting to improvenursing students’ critical thinking: an evidence review. J Nurs Educ.2011;50(3):145–51.
73. Pennington K, Moscatel S, Dacar S, Johnson C. EBP partnerships: buildingbridges between education and practice. Nurs Manag. 2010;41(4):19–23.
74. Phelps SF, Hyde L, Planchon WJ. Introducing information literacycompetency standards for nursing. Nurse Educ. 2015;40(6):278–80.
75. Phillips RM. Creative classroom strategies for teaching nursing research.Nurse Educ. 2014;39(4):199–201.
76. Pierce LL. The e-poster conference: an online nursing research courselearning activity. J Nurs Educ. 2016;55(9):533–5.
77. Putnam J, Faltermeier D, Riggs CJ, Pulcher K, Kitts R. Conquering evidence-based practice using an embedded librarian and online search tool. J NursEduc. 2011;50(1):60.
78. Raines DA. A collaborative strategy to bring evidence into practice.Worldviews Evid Based Nurs. 2016;13(3):253–5.
79. Raurell-Torredà M, Romero-Collado À. Simulation-based learning as atactic for teaching evidence-based practice. Worldviews Evid BasedNurs. 2015;12(6):392–4.
80. Reicherter EA, Gordes KL, Glickman LB, Hakim EW. Creating disseminatorchampions for evidence-based practice in health professions education: aneducational case report. Nurse Educ Today. 2013;33(7):751–6.
81. Revaitis M, Egger S. FaceTime: a virtual pathway between research andpractice. Nurse Educ. 2013;38(5):186–7.
82. Roberts D, Ousey K. Finding and using evidence in academic assignments:the bane of student life. Nurse Educ Pract. 2011;11(5):333–40.
83. Rodriguez R. Action research as a strategy for teaching an undergraduateresearch course. J Nurs Educ. 2012;51(2):102–5.
84. Rolloff M. A constructivist model for teaching evidence-based practice. NursEduc Perspect. 2010;31(5):290–3.
85. Ruskjer B. A real-world experience to engage students in evidence-basedpractice. J Nurs Educ. 2010;49(11):660.
86. Ruzafa-Martinez M, Lopez-Iborra L, Armero Barranco D, Ramos-Morcillo AJ.Effectiveness of an evidence-based practice (EBP) course on the EBPcompetence of undergraduate nursing students: a quasi-experimentalstudy. Nurse Educ Today. 2016;38:82–7.
87. Schams KA, Kuennen JK. Clinical postconference pedagogy: exploringevidence-based practice with millennial-inspired ‘building blocks’. CreativeNurs. 2012;18(1):13–6.
88. Schreiner M, Kudrna B, Kenney C. How undergraduate students cancontribute to EBP. Nurs Manag. 2015;46(9):21–3.
89. Scott PJ, Altenburger PA, Kean J. A collaborative teaching strategy forenhancing learning of evidence-based clinical decision-making. J AlliedHealth. 2011;40(3):120–7.
90. Scurlock-Evans L, Upton P, Rouse J, Upton D. To embed or not to embed?A longitudinal study exploring the impact of curriculum design on theevidence-based practice profiles of UK pre-registration nursing students.Nurse Educ Today. 2017;58:12–8.
Larsen et al. BMC Medical Education (2019) 19:259 Page 32 of 33
91. Sin MK, Bliquez R. Teaching evidence based practice to undergraduatenursing students. J Prof Nurs. 2017;33(6):447–51.
92. Smith-Stoner M. Developing new writers: answering the call for studentmanuscripts. Dimens Crit Care Nurs. 2011;30(3):160–3.
93. Smith-Strøm H, Oterhals K, Rustad EC, Larsen T. Culture crash regardingnursing students’ experience of implementation of EBP in clinical practice.Vard i Norden. 2012;32(4):55–9.
94. Stombaugh A, Sperstad R, Vanwormer A, Jennings E, Kishel H, Vogh B.Using lesson study to integrate information literacy throughout thecurriculum. Nurse Educ. 2013;38(4):173–7.
95. Strickland K, Gray C, Hill G. The use of podcasts to enhance research-teaching linkages in undergraduate nursing students. Nurse Educ Pract.2012;12(4):210–4.
96. Sukkarieh-Haraty O, Hoffart N. Integrating evidence-based practice into aLebanese nursing baccalaureate program: challenges and successes. Int JNurs Educ Scholarsh. 2017;14(1). https://doi.org/10.1515/ijnes-2017-0026.
97. Whalen KJ, Zentz SE. Teaching systematic searching in a baccalaureatenursing research course. Worldviews Evid-Based Nurs. 2015;12(4):246–8.
98. Wonder AH, Otte JL. Active learning strategies to teach undergraduatenursing statistics: connecting class and clinical to prepare students forevidence-based practice. Worldviews Evid Based Nurs. 2015;12(2):126–7.
99. Yu D, Zhang Y, Xu Y, Wu J, Wang C. Improvement in critical thinkingdispositions of undergraduate nursing students through problem-basedlearning: a crossover-experimental study. J Nurs Educ. 2013;52(10):574–81.
100. Zhang Q, Zeng T, Chen Y, Li X. Assisting undergraduate nursing students tolearn evidence-based practice through self-directed learning and workshopstrategies during clinical practicum. Nurse Educ Today. 2012;32(5):570–5.
101. Albarqouni L, Hoffmann T, Straus S, Olsen NR, Young T, Ilic D, et al. Corecompetencies in evidence-based practice for health professionals:consensus statement based on a systematic review and Delphi survey.JAMA Netw Open. 2018;1(2):e180281.
102. Ahmadi S, Baradaran HR, Ahmadi E. Effectiveness of teaching evidence-based medicine to undergraduate medical students: a BEME systematicreview. Med Teach. 2015;37(1):21–30.
103. Albarqouni L, Hoffmann T, Glasziou P. Evidence-based practice educationalintervention studies: a systematic review of what is taught and how it ismeasured. BMC Med Educ. 2018;18(1):177.
104. Tilson JK, Kaplan SL, Harris JL, Hutchinson A, Ilic D, Niederman R, et al. Sicilystatement on classification and development of evidence-based practicelearning assessment tools. BMC Med Educ. 2011;11(1):78.
105. Shaneyfelt T, Baum KD, Bell D, Feldstein D, Houston TK, Kaatz S, et al.Instruments for evaluating education in evidence-based practice: asystematic review. JAMA. 2006;296(9):1116–27.
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