A hierarchy of effective teaching and learning to acquire competence in evidenced-based medicine

EBM requires that health care decisions be based on the best available valid and relevant evidence. To achieve this, teachers delivering EBM curricula need to inculcate amongst learners the skills to gain, assess, apply, integrate and communicate new knowledge in clinical decision-making. Empirical and theoretical evidence suggests that there is a hierarchy of teaching and learning activities in terms of their educational effectiveness: Level 1, interactive and clinically integrated activities; Level 2(a), interactive but classroom based activities; Level 2(b), didactic but clinically integrated activities; and Level 3, didactic, classroom or standalone teaching.All health care professionals need to understand and implement the principles of EBM to improve care of their patients. Interactive and clinically integrated teaching and learning activities provide the basis for the best educational practice in this field.Evidence-based medicine (EBM) is often taught and learnt through attendance at courses, conferences, workshops, journal clubs, educational meetings, surveillance of medical literature and guidelines, and investments in textbooks [1]. Many of these activities fall under broader concepts such as Continuing Professional development (CPD) [2], Knowledge Translation (KT) [3] and Continuing Medical Education (CME). The process of EBM [4] includes formulating structured queries from specific clinical problems, searching and acquiring relevant literature, appraising it for quality and, if appropriate, applying the findings taking into account patient's own preferences and values. EBM aims to incorporate more holistic perspectives, enlisting effective implementation strategies using the influence of CME [5]. The trigger for enlisting in EBM related educational activities usually isn't the identification of an information need to resolve a particular clinical problem from a specific patient encounter, but rather a general wish to update oneself.The different approac