Core, Evidence Application, Research (CEAR): a Theory to Frame Separate Skills for Evidence-Based Practice and Research in Medical Education.

Abstract

Research is embedded into the curriculum of most US medical schools. However, there is a great deal of variety in the curricular approaches to teaching research. Further, some programs choose to focus on teaching the conduct of research while others focus on the application of research findings (i.e. evidence-based practice). This variation may lead to conflation of two independent skill sets. This investigation advances a theory (called CEAR-Core, Evidence Application, Research) that research skills and evidence-application skills are independent from one another. We evaluated the CEAR model using a pre-post design and paired t-tests at a medical school with defined curricula in both research and evidence-based practice. We found that medical student skills were low in CEAR model Core skills (approximately 42% of possible maximum score on the CEAR tool at baseline). Core and Research skills increased at each timepoint, although whether the changes were significant varied by research subdomain. Evidence-application scores improved after evidence-based practice activities within the curriculum (22.8 ± 16.4% to 30.2 ± 18.4% p < 0.001), but did not increase significantly further after the research experience (30.2 ± 18.4% to 36.5 ± 17.3%, p = 0.126). Limitations include the single medical school design and the limited number of students who completed all three data collection timepoints. Overall, we believe CEAR is a valid model for medical educators to use to conceptualize the separation of research and evidence application, the core skills required for both, and the sub-domains, in their development of curricula. Additionally, the CEAR tool may be useful for student assessment and curricular evaluation.