Trial design
In this non-randomized controlled trial, PGY-1 and PGY-2 medical residents were studied at Baqiyatallah Hospital of Tehran, Iran. All medical residents were presented with a briefing about the EBP assessment thereafter, they filled the questionnaires. The participants allocated to the active group received a weekly 2 hours EBP-structured presentation covering EBP approaches to patient care experiences offered by the EBM faculty team of the Baqiyatallah University of Medical Sciences. Participants of the passive education group were assigned to our new EBP-oriented curriculum for a year. Teachers and participants were all informed about the courses they were going to attend. Therefore, blinding and allocation concealment were not possible in the present study. Nevertheless, the intention of the study had not been disclosed to the participants. Written informed consent was obtained from each participant. All procedures were approved by the ethics committee of Baqiyatallah University of Medical Sciences (approved no: IR.BMSU.BAQ.REC.1398.020). Participants who did not consent to participate in the study or did not attend at least 50% of classes were excluded from the study.
Educational intervention
The educational intervention of the EBP course was developed by qualified EBP professors of Baqiyatallah University of Medical Sciences. This course was intended to provide an interactive forum for participants to improve the clinical implementation of EBM. The primary outcome of this study was knowledge, attitudes, outcome/decision, and behavior, which was measured by using the previously validated evidence-based practice knowledge, attitude, behavior questionnaire (EBP-KABQ) tool (11). Due to the busy schedule of medical residents and the COVID-19 pandemic, presentations were given in-class and online for only two hours per week. Therefore, participants could attend either class as they preferred. Classes were according to the COVID-19 precaution protocols. Because of the current time pandemic and involving all medical residents, most of the examples, articles, and presentations were based on COVID-19. In total, participants in the active group received a 12-h EBP course. The training course is outlined in Additional file 1: Table S1. The introduction session provided an overview of EBP in brief. The following four sessions were created based on the 5-step model of EBP principles, consist of development clinical question and search strategy, a systematic literature search of medical databases, critical appraisal, and evidence synthesis, apply the evidence to the relevant case scenario. Each session was devoted to a single study type (observational, diagnostic, therapeutic, systematic review and meta-analysis studies). The final session (sixth session) presented three actual clinical examples of COVID-19-related dilemmas to demonstrate the real-time application of EBP skills. The EBM faculty teaching team consists of two professors and one novice teacher. Each session was taught by multiple teachers. Also, participants were allowed to ask questions and faculty members were responsive during the training period. The passive educational group received EBP education through their daily rounds, evidence-based journal clubs, and morning reports.
Evaluation instruments
Assessment of knowledge, attitude, outcome and behavior in participants
Knowledge, behavior, outcome or decision, and attitude were measured before and after EBP training using the EBP-KABQ tool. Assessment questionnaires consisted of 33 questions answered using the Likert scale (11). This questionnaire was presented in the English language to our participants.
Assessment of competency in EBP
Although the EBP-KABQ questionnaire has been developed to measure users' knowledge, behavior, and attitude, it does not examine the skills and competency of individuals in evidence-based medicine (EBM). Recently, The Assessing Competency in EBM tool (ACE tool) has been developed by Ilict et al (12).
This questionnaire presents a brief clinical scenario from which a clinical question is developed. Users are then presented with a search strategy and a hypothetical article extract. Users then work through 15 questions (answering yes or no), with each question representing a step in EBM. Items 1–11 assess knowledge and skills relevant to EBM, whilst items 12–15 assess attitudes relevant to EBM implementation in clinical practice. The tool has been found to be a reliable and valid instrument to assess medical trainees' competency in EBM (12). This questionnaire was presented in the English language to our participants.
Statistical Analysis
Statistical analyses were performed using the SPSS software version 25.0 for Windows (SPSS Inc., Chicago, IL). The Levene and Kolmogorov-Smirnov tests were used to examine the equality of variances and distribution of variables, respectively. In case of a normal distribution, an independent t-test was applied to compare mean values of quantitative variables, otherwise, the Mann-Whitney U test was used. The qualitative and quantitiave variables are presented as numbers (proportions), and mean ± standardized deviations (SDs). Differences in categorized variables was analyzed by chi-square test. Before and after analysis was performed using paired t-test. All statistical tests were 2-tailed, and p<0.05 was considered statistically significant.