Undergraduate physiotherapy students’ competencies after a reorganization of the educational pathways in EBP: time and type of activity are relevant?

Relevance: Evidence Based Practice (EBP) constitutes core competencies to be acquired by physiotherapy undergraduates. Literature provides indications to design educational pathways, but evidence regarding effectiveness of different educational approaches in EBP is limited. Type of activity and time may be relevant factors for learning. Purpose: The EBP educational pathways (Physiotherapy Undergraduate program, University of Ferrara) had to be reorganized due to an increase in the number of students and implementation of university’s reform law. Due to time constraints the total amount of hours dedicated to EBP had to be reduced and the Journal Club activity had to be discontinued. Aim of the study was to evaluate the effectiveness of the revised EBP educational pathways. Objectives: 1) assess students’ knowledge, skills and clinical behaviors related to EBP, after each year’s reorganized multimodal educational pathway; 2) compare effectiveness of reorganized educational pathways with respect to the previous ones. Approach/evaluation: Physiotherapy undergraduates of the 1st, 2nd and 3rd year (University of Ferrara, academic year 2013–14) and a group of students not yet exposed to any EBP educational activity (academic year 2014–15), who voluntarily agreed to participate. The students attended the reorganized educational pathways activities (interactive seminar in the 1st year and lessons in the 2nd year; specific learning goals in their clinical internship in all three years; specific EBP assignments in their clinical internship in the 2nd and 3rd year). Their EBP knowledge and skills were assessed, after the educational activities, using the Italian validated version of the Adapted Fresno Test. Students’ clinical behaviour related to EBP (2nd and 3rd year)was evaluated by auditing the internship documentation through a piloted form. Overall results were compared with the ones of previous pathway. Adapted Fresno Test score between-group comparison were conduced (t-test for unpaired data,Wilcoxon test). The results of clinical internship documentation audit weredescribed through descriptive statistical analysis. Outcomes: 101 students (83% of the total) participated in the study. Adapted Fresno Test mean difference was statistically significant in all comparisons between-group. 27% of the 2nd year and 77% of the 3rd year students reached the 50% cut-off of maximum obtainable score; gains regarded the items related to specific learning outcome of each year. Comparison between outcome of different educational pathway showed total test score statistically significant decrease in all three years (except increase of some items in the 3rd year). Clinical internship documentation audit gave evidence of PICO/question formulation (40–100%) and database search (50–100%); more difficulties were found in behaviors related to critical appraisal of internal (35–45%) and external validity (5–30%). The correct application generally ranged from 30% to 90%. Discussion and conclusions: The new multi-modal educational pathways was less effective in educating students in EBP and main reasons could be the reduction of amount of time dedicated to EBP, the lack of Journal Club activities and of a formal assessment in 1st year.