Fact-checking in Evidence-Based Medicine in Physiotherapy undergraduate students.

doi:10.21203/rs.3.rs-3224584/v1

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Fact-checking in Evidence-Based Medicine in Physiotherapy undergraduate students.

https://doi.org/10.21203/rs.3.rs-3224584/v1

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Introduction

Fact-checking is an innovative teaching methodology that allows training professionals who are critical of the information they receive, and comparing data to determine its validity by instilling in them an evidence-based work methodology, thus benefiting both their clinical practice and the quality and safety of the care they provide to their patients. The objective was to determine the effect of a training activity based on fact-checking and developed using learning-by-doing methodology in knowledge acquisition, research skills, and comparison of information by physiotherapist students, as well as to determine their satisfaction with the training activity.

Methods

Teaching innovation study carried out through a learning methodology based on learning-by-doing on fact-checking in physiotherapy. Twenty-five students participated, randomly divided into working groups. They selected and analysed the methodological quality of a treatment technique published in a scientific article and reproduced it under the same conditions. Then, they applied critical reasoning to the results obtained. The application and reasoning of the scientific method were assessed quantitatively, and the student’s understanding of the training activity was assessed qualitatively.

Results

The average grade obtained was 8.29. Satisfaction with the activity was 4.16 out of 5, highlighting the application to professional activity with 4.17/5. Finally, students highlighted the learning received on properly conducting scientific research.

Conclusion

A training action based on fact-checking and developed through learning-by-doing allows students to acquire the skills to assess the information they receive on physiotherapy critically and helps them to make better clinical decisions, always based on quality scientific evidence.

Fact-Checking

Evidence-Based Medicine

Health Sciences

Physiotherapy

Undergraduate students

In the age of digital information and social networks, disseminating non-verified or false news and data is a constantly growing phenomenon [1], in which the field of health is also included [2]. Up to 82.1% of the Spanish population uses the internet and social networks to look for information on science and health [3], which increases among young people, especially on social networks[4]. Infodemic or overabundance of content confuses and makes it difficult for individuals to distinguish between reliable and unreliable sources [5].

This scenario is transferred to the healthcare field, specifically to Evidence-Based Medicine. With more than 17 million human studies published in Pubmed, and thousands of new ones every year [6], there is a proliferation of literature with inaccurate, falsified data and high methodological quality biases that could determine diagnostic and treatment decisions, which is why healthcare professionals must be selective in what they read [7]. To do this, they must be able to select and critically assess articles to ensure that the conclusions are valid and applicable to their practice[8]. It has been observed that problems related to uncertain reliability of evidence, combined with a high percentage of healthcare professionals lacking the necessary skills to assess the quality and usefulness of medical evidence, mean that conventional literature searching, although necessary, is insufficient to ensure a correct clinical practice [6].

The current trend in university learning is to encourage autonomous and collaborative learning; however, it is essential to provide students with skills related to the verification of Evidence-Based Medicine so that they can discern what information is accurate and what is not, based on scientific and technical criteria, creating opinions based on quality scientific evidence. It is at this point where the importance of new teaching methodologies stands out, such as fact-checking, transferred to Evidence-Based Medicine, which can be used to train physiotherapy professionals who are critical and capable of adequately assessing the information they receive and applying it safely in their clinical practice [9].

The study aimed to determine the effect of a training activity based on fact-checking, and it was developed using a learning-by-doing methodology on acquiring knowledge and research and information comparison skills by physiotherapy students.

The student’s understanding of the tasks performed and the fact-checking learning they reported regarding the methodology used, the learning obtained, and the transfer of this learning was also assessed.

The didactic methodology was based on “learning-by-doing” research by developing a research simulation model in a critical reasoning competence context.

Physiotherapy undergraduate students were divided into seven working groups during the first semester of the fourth 2022–2023 school year course. The work was divided into five learning blocks consisting of three stages: teaching and theoretical basis, completion of tasks, and feedback on the task performed. The tasks were carried out progressively up to the simulation of the publication of an article and the defence of a poster of the work carried out at a scientific congress. The work blocks were as follows: 1) Review of the literature on a physiotherapy technique to be “Checked.” 2) Reproduction of the chosen technique under the same conditions as the reference study. 3) Implementation of a research project. 4) Critical analysis of the results obtained compared with the reference study and 5) carrying out a poster and its defence at the congress simulation.

Before making and defending the poster and implementing knowledge and competencies in the students, a follow-up was carried out where the students had to hand in recurring tasks in each block, receiving feedback from the teacher responsible for the subject.

A scientific congress simulation was carried out for the poster’s assessment, where four Ph.D. lectures from the faculty, not linked to the subject, created the scientific committee. In order to obtain the final grade, a specific rubric was created based on the teaching provided and the reasoning applied to the results of the original technique compared with those obtained by the students. The average grade was calculated on a scale of 0 to 10.

Twenty-four hours after the end of the congress simulation, the students were asked to assess the activity using an anonymous questionnaire on Google Forms consisting of 17 questions about the participants’ understanding and satisfaction with the collaborative teaching methods, their interest, and the applicability of the activity in their professional future. A Likert-type scale was used to answer 14 questions, while the three qualitative questions related to the strengths and weaknesses of the activity had an open-ended response.

In order to analyse the results of the study, the learning outcomes were rated on a scale of 1 to 10. On the other hand, the assessment of the student’s understanding was rated from 1 to 5, attributing lower scores to low satisfaction and higher scores to high satisfaction. It was also subdivided into four blocks that rated the methodology used, the staging of the simulation, the learning achieved, and the transfer of this learning to the profession.

A total of 25 students participated in the study, 60% males and 40% females. The average age of the group was 25.8 ± 4.64 years. The overall mean score obtained through the rubric for the poster presentation was 8.29 ± 1.54 (out of 10), ranging between 5 and 9.5.

Regarding understanding the task and the learning obtained, students rated different items in four areas/blocks: understanding of the methodology used, simulation of the activity, understanding of the learning acquired, and understanding of the transfer of the learning obtained. Generally, the average overall satisfaction with the activity was 4.16 ± 0.88 (out of 5).

In the satisfaction assessment in the section related to understanding the methodology used, an average score of 4.23 ± 0.70 out of 5 was obtained. In the second block, related to the experience of simulating the activity, an average satisfaction rating of 4.14 ± 0.87 was obtained. Finally, in the last two areas related to understanding the learning obtained and the understanding of its transfer to the profession, the values were 4.18 ± 0.92 and 4.17 ± 1.13, respectively (Table 1).

Table 1

Students’ understanding and satisfaction regarding the activity carried out.
Student understanding	Average ± standard deviation
Understanding the methodology used
The methodology used in this training	3.96 ± 0.81
Information provided to prepare the activity	4.04 ± 0.75
Handing out activities progressively	4.38 ± 0.65
Feedback provided by the teacher	4.54 ± 0.59
Activity simulation
Staging of the activity – Congress simulation	4.42 ± 0.72
It is an enjoyable and didactic way of learning	3.83 ± 1.13
Understanding the learning achieved
It helped me to self-assess my knowledge	4.13 ± 1.08
Learning achieved	4.33 ± 0.64
This activity helped me to prepare the content for other subjects	4.08 ± 1.06
Understanding the transfer of fact-checking to the profession
Intellectual motivation	3.88 ± 1.12
Integration of knowledge	4.33 ± 0.82
Importance in training	4.33 ± 0.87
Application to professional practice	4.17 ± 1.13

In terms of the qualitative aspect, regarding the open-ended questions related to the strengths and weaknesses of the activity, three categories were included: How do you think this activity has helped you to learn? What disadvantages have you found? And, What advantages do you think this type of activity offers compared to the usual teaching experience?

Nineteen students commented on the first category, most of them (13) highlighting that this task has helped them know how to carry out a research paper in structure and content. They pointed out that the number of corrections received and grouped by sections helped them to differentiate what is important to include in each of the sections and that, therefore, it helped them to have a basic knowledge of how to carry out a research project or how to face a congress. Likewise, the usefulness of integrating knowledge and motivation to face the scientific area of their profession was also indicated.

Twenty-one students commented on the category What disadvantages have you found? They indicated that the main difficulty was time (12 comments). They considered that the activity involved much time to invest due to the workload; they indicated a lack of time that makes it difficult to carry out corrections and the time taken away from other academic tasks like preparing other subjects or working on the final year dissertation.

On the other hand, reference is made to the high workload and its demands. Although this was mentioned as a difficulty, it was pointed out that it was not a disadvantage and even appreciated. In some cases, students reported difficulties in attending tutorials because they had other academic activities, such as attending clinical practice, but they highlighted that the professor was fully available.

Finally, the need for more training or background in the scientific area to carry out the activity is mentioned as a difficulty.

Seventeen out of 25 students answered the third and last category, What advantages do you think this type of activity offers compared to the usual teaching experience? One of the most commonly mentioned advantages is the learning obtained through the personal work accomplished. Some nine students directly referenced this, pointing out that concepts are reinforced and remembered, as in the typical teaching situation. Together with this, students highlighted the personal demand and the use of skills or techniques to solve difficult situations they have faced, feeling prepared to use the knowledge acquired in the immediate future and an actual situation. They also pointed out as an advantage the acquisition of a different kind of learning that has yet to be paid much attention to and mitigates the knowledge deficiency they have in terms of scientific work. Finally, the didactic nature of the activity is highlighted, encouraging active participation and its entertaining nature, which helps effort and group work, motivating the class by leaving the academic routine behind.

This study emerged from the teachers’ concern to improve teaching quality and bring it closer to today’s society. Using the paradigms of Responsible Research and Innovation -RRI[10], the aim was to bring together the transversal concepts that relate science and innovation with society, along with the contribution of scientific evidence, in this specific case, to provide physiotherapy students with the necessary skills for the verification of scientific literature, thereby promoting access to reliable and truthful information, which will be transferred to a safe, effective clinical practice based on the latest available quality evidence [10].

For research as a whole and health science in particular, given the speed of data generation and the urgent need to publish, a systematic way of using the information accessed is often to assume that if it is referenced, it is true, without contrasting it or analysing it through a process of analysis and critical thinking[11]. Mainly as it is known that up to 34% of scientists have admitted to having carried out questionable research practices on some occasion [12] or that there is a frequency of 0.02% of article retraction in PubMed due to malpractice or mala praxis; this has been calculated based on the frauds discovered, which underestimates the accurate data, so that some authors suggest that up to 0.2% of the articles published may be fraudulent[13].

That is why training activities such as the one presented in this paper are essential to instil in students a culture of scientific verification of all the information they receive, understanding that not everything they read in any source of dissemination is reliable and must be corroborated [14].

To this end, an activity was created using a fact-checking methodology to corroborate accepted beliefs in physiotherapy, built on knowledge of dubious quality, using a learning didactic based on learning by doing and collaborative learning, through which the students conducted research in a context of critical reasoning competence [15].

In the teaching-learning process, the constructivist learning-by-doing methodology is presented as a practice whose relationship with the retention of knowledge by the students is highly positive [16, 17]. This fact can be seen in the marks achieved in the work presentation, which obtained an average of “B.” Students also perceived that in this activity, concepts are reinforced and remembered and that the didactic nature of the activity encourages active and collaborative participation, which motivates them to make an effort. On the other hand, some occasional difficulties were identified, which can be explained by the students’ limitations in public presentation due to a lack of training and/or the presence of factors such as fear, embarrassment, or phobia. It should also be considered that they are used to a one-way model of exposition [18]. Curiously, the students do not perceive this phenomenon as a disadvantage in carrying out the activity, and the congress simulation experience is even assessed with an average of 4.14 ± 0.87 (out of 5).

Generally, the satisfaction values obtained are very high in all the blocks. The score for the methodology used stands out at 3.96 out of 5. Considering the results of the open-ended questions, it seems that this lower rating is not due to the methodology itself, which they indicated has greatly helped them in preparing their research, but to other organizational factors such as the limited time given and the low level of prior knowledge of the subject. In addition, they stated a high level of satisfaction with transferring this knowledge to other areas of educational development, such as preparing the final thesis. On the other hand, the high satisfaction with the activity reinforces the fact that teaching efforts should focus on raising students’ awareness of the limitations of the evidence, training them to make a critical assessment, and improving their communication skills so that they can summarise and discuss medical evidence effectively both in professional settings and with patients to improve decision-making and clinical practice [17, 19].

Although the study’s results are solid and allow us to demonstrate the effectiveness of the educational intervention, it is important to highlight the limitations encountered during this research. The first is due to the scarce literature on fact-checking as a teaching tool, especially in physiotherapy. This aspect has determined both the study’s conceptualization and the discussion itself. On the other hand, this research was carried out on a small sample of students; therefore, it is necessary to conduct more studies with larger samples in order to be able to compare the results obtained.

Considering all of the above, it can be stated that a training activity based on fact-checking and developed through learning-by-doing allows students to acquire the knowledge and skills to critically evaluate the information they receive on physiotherapy, helping them to make better clinical decisions always based on quality and corroborated scientific evidence, as well as acquiring another series of fundamental skills such as the synthesis of information, critical thinking and public presentation, which greatly enhance their scientific and professional development. Moreover, in general terms, the students consider this activity to be highly satisfactory.

Ethics approval and consent to participate: Google Forms questionnaire used was anonymous and voluntary. It was considered exempt from the requirements of approval of the Pontifical University of Salamanca, relating to educational innovation projects and developed under the protection of the teaching activity; no ethically committed intervention was carried out, but only the academic and satisfaction results of a teaching innovation action were analysed. Consent was obtained for the processing of information in accordance with the Data Protection Act in accordance with the provisions of Organic Law 3/2018 on the Protection of Personal Data, of 5 December. Participants were informed that their data would be collected and used for this study. Participants gave their consent on the first screen at the start of the online questionnaire. No personal information was gathered. Study did not require registration in Registry of Clinical Trials. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Consent for publication: not applicable

Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests: The authors declare that they have no competing interests

Funding: No funding was received for this study.

Authors' contributions: Perpiñá-Martínez, Álvarez-Comino and Quintana-Alonso contributed to the design of this study. Perpiñá-Martínez contributed to teaching data collection and analysis. Perpiñá-Martínez, Álvarez-Comino and Quintana-Alonso contributed to the original manuscript writing. Perpiñá-Martínez contributed to the data analysis. Perpiñá-Martínez, Álvarez-Comino and Quintana-Alonso contributed to the manuscript revision. All the authors read and approved the final manuscript.

Acknowledgements: The authors would like to thank the students who participated, for their interest and effort in participating in new learning methodologies.

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No competing interests reported.

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Fact-checking in Evidence-Based Medicine in Physiotherapy undergraduate students.

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Abstract

INTRODUCTION

METHODS

RESULTS

DISCUSSION

CONCLUSIONS

Declarations

References

Additional Declarations

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