Evidence-based practice involves combining the best available research evidence with professional expertise, the circumstances of the person or situation, and relevant preferences and values when making professional decisions.
It is therefore broader than research literacy or critical appraisal.
A student might be very good at identifying weaknesses in a research paper but still struggle to use evidence effectively in practice. Evidence-based practitioners need to recognise when evidence is required, find appropriate information efficiently, judge its trustworthiness and relevance, and decide how it should influence what they do.
A commonly used evidence-based practice process is:
Teaching evidence-based practice should therefore help students learn how to move from a professional problem to an evidence-informed decision, rather than treating searching and critical appraisal as ends in themselves.
Teaching evidence-based practice has a very large positive effect on undergraduate students’ evidence-based practice competency ➕➕➕➕➕ [1]. Evidence-based practice education has also been associated with large improvements in critical thinking and problem-solving ➕➕➕➕➕ [1].
Broader evidence across health-professions education shows that evidence-based practice education consistently improves students’ knowledge and generally improves their evidence-based practice skills. There is also evidence of positive changes in students’ evidence-based behaviour, although effects on attitudes are less consistent [2].
There is no compelling evidence that one particular teaching modality is best [3]. Online, face-to-face, blended, problem-based and other approaches have not demonstrated consistent superiority over one another. The more important principle appears to be that students have opportunities to actively perform evidence-based practice, rather than only learn about it [2,3].
Multifaceted and professionally integrated approaches are particularly promising [2]. This means connecting searching and critical appraisal with authentic professional questions and requiring students to use evidence to reach and justify a decision.
This summary is informed by one recent meta-analysis of undergraduate nursing students, an overview of systematic reviews across health-professions education, and a systematic review of randomised trials comparing different approaches to teaching evidence-based practice [1–3].
The most directly applicable meta-analysis included 11 controlled studies of undergraduate nursing students, with eight included in meta-analysis [1]. Evidence-based practice education had a very large effect on evidence-based practice competency (SMD = 1.55), with similarly large effects on critical thinking (SMD = 1.29) and problem-solving (SMD = 0.65). However, most included studies were non-randomised, the evidence was restricted to nursing students, and heterogeneity for the main outcome was very high (I² = 92%). We therefore rate this evidence as low quality ➕➕.
A broader overview included 22 systematic reviews containing 141 primary studies across different levels of health-professions education [2]. Knowledge generally improved following evidence-based practice education, as did skills among undergraduate students. Evidence-based behaviour also improved in undergraduate populations, while effects on attitudes were inconsistent. However, there was considerable overlap between reviews and most of the included systematic reviews were rated critically low quality.
A further systematic review included 21 randomised controlled trials directly comparing different ways of teaching evidence-based practice [3]. It found no single teaching modality that consistently produced better evidence-based practice competency than another. This supports choosing delivery methods according to the learning context rather than assuming that online, face-to-face, blended or another format is inherently superior.
