From blog introduction: “Health Services are in crisis, everywhere. More of the same is not the answer. A new paradigm is needed and we have set up  Better Value Healthcare to help people move to that new paradigm. We have developed resources and packaged them into ten solutions. These are delivered in a rage of ways – online, on paper and face to face

This particular site also summarises  the resources I have been producing since entering the public health service. My first article on culture was published in The Lancet in 1977, my first on how systems could increase healthcare value in the same journal in 1983. since then i have had many opportunities to develop these ides , and been educated by many many wonderful colleagues. For example the opportunity to create  national screening programmes which screened about 8 or 9 million people a year allowed me to learn about systems and networks, and the importance of treating citizens as intelligent equals. The opportunity to create the National Library for Health, now manifest as NHS Evidence and NHS Choices let me learn about knowledge quality and the Internet and mu long standing interest in language, the focus of my 1977 paper, and the opportunity to mingle with the anthropologists and philosophers of Oxford has helped me develop my ideas on culture and these five drivers, citizens, knowledge, . the Internet, systems and culture will dominate the next five years work.”

Abstract

Context  Evidence-based practice (EBP) is the integration of the best research evidence with patients’ values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness.

Objective  To appraise, summarize, and describe currently available EBP teaching evaluation instruments.

Data Sources and Study Selection  We searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument.

Data Extraction  Two raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes.

Data Synthesis  Of 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures.

Conclusions  Instruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

Evaluation tools: EBM Fresno Test | Berlin Questionnaire