Protocol for a Systematic Review: E‐learning of Evidence‐Based Health Care to Increase EBHC Competencies in Healthcare Professionals

BACKGROUND The need for evidence-based health care competencies Evidence-based medicine (EBM), introduced in 1991, has its roots in the field of clinical epidemiology and was listed as " one of the 15 greatest medical milestones since 1840 " in the British Medical Journal (Montori & Guyatt, 2008). The most commonly used definition of evidence-based medicine (EBM) describes it as " the conscientious, explicit and judicious use of the current best evidence in making decisions about the care of individual patients ", 1996). It thus requires practitioners to bring together external evidence about the effects of new tests, treatments and interventions, clinical judgement and expertise, and the patient's clinical state, values, preferences, needs and predicament. EBM is now more commonly referred to as evidence-based practice (EBP) or evidence-based health care (EBHC), as EBM is not limited to medical doctors, but should be adopted by all healthcare practitioners. Practicing EBHC typically involves five steps: (i) formulating an answerable question from a healthcare problem; (ii) finding the best available evidence applicable to the question; (iii) critically appraising the evidence for validity, clinical relevance, and applicability; (iv) applying the results of the evidence in the healthcare setting; and (v) evaluating the performance (Dawes et al., 2005). An important aim of EBHC is that beneficial, effective health care practices are adopted, and that harmful and ineffective ones are abandoned. Consequently, this requires healthcare professionals to recognise their deficiencies in knowledge and to adopt a philosophy of lifelong learning, which is the backbone of practicing EBHC (Greenhalgh & Macfarlane, 1997). The importance of the knowledge, skills, and attitude learnt through the principles of EBHC is also highlighted in the Lancet report on the health professional for the 21 st century (Frenk et al., 2010), which proposes that healthcare professional training become transformative. One of the fundamental shifts of transformative learning aligns almost perfectly with the steps of EBHC: the shift from memorization of facts to " critical reasoning that can guide the capacity to search, analyse, assess and synthesise information for decision-making " (Frenk et al., 2010). In addition, Glasziou and colleagues (2011) have urged educational institutions to teach medical students skills that enable them to become lifelong learners so that they are able to combine external evidence from research with their own expertise and their patients' values and preferences. They emphasize that teaching EBHC skills should form an integral part of the medical curriculum and …