Evaluation of Improved Evidence-Based Patient Care Application During a Primary Care Advanced Practice Experience

Purpose: To evaluate improvement in application of critical thinking and evidence-based recommendations on case-based test responses during a primary care advanced practice experience.

Methods: During a 5-week primary care advanced practice experience, three faculty members sought to deepen understanding of relevant primary literature to assist fourth-year professional students in gaining insight into patient-specific applications. Key research articles on the subjects of hypertension, dyslipidemia, and diabetes were identified to review with the students.  Additionally, biomedical literature evaluation exercises and practice cases were developed for discussions to verbalize their conclusions and rationale in clinical decisions.  The faculty corrected any misunderstandings and helped sharpen critical thinking abilities.  An examination was prepared to assess critical thinking and student application of this biomedical literature in clinical decision making and individualized care.  This examination was administered to the students during the first week of the rotation and prior to the therapeutic discussions as well as during the last week of the rotation as a portion of their rotation grade.  A paired t-test was conducted to evaluate changes in pre- and post-scores on this examination as a result of the evidence-based therapeutic discussions. 

Results: Thirty students were examined and the mean change in scores was a 27.9 improvement (p < 0.05). The mean prescore was 57.7 and mean postscore was 85.5. The primary areas of improvement: defending patient-specific recommendations with detailed results from the literature and independent of pharmacologic effects (ie cardiovascular outcomes with metformin); compare and contrast therapies with and without evidence of health outcomes (reduced morbidity and mortality); identifying areas for optimization in therapy for primary or secondary prevention, and identified drug-related problems.

Conclusion: Integrating informal primary literature activities into a primary care rotation deepened understanding and improved critical thinking and patient care application of therapeutic recommendations.  The teaching time dedicated to such activities was reasonable.