Interprofessional Evidence-Based Practice Competencies: Equalizing the Playing Field

The study by Albarqouni et al¹ provides a broad, interprofessional view of proposed competencies for evidence-based practice (EBP) in the health professions. The study is grounded in an extensive systematic review, followed by an iterative ranking that was validated by selected thought leaders in the field through a modified Delphi survey study. The authors’ effort deserves accolades for its thoughtful design, international and interprofessional participation, and comprehensive inclusion of 68 competencies in 27 domains. The domains mirror the well-established 5-step evidence-based medicine framework of ask, acquire, appraise, apply, and evaluate. This consensus statement now provides a framework to help educators design curricula and evaluation tools in EBP.

Competencies describe a measurable set of behaviors that build on one’s knowledge, skills, and attitudes to complete specific tasks.² While competencies identify the specific activities to achieve, the American Association of Medical Colleges has more recently promoted the use of entrustable professional activities (EPAs), defined as activities a medical professional is expected to successfully complete without supervision. In the realm of EBP, the American Association of Medical Colleges identifies the following EPA: to “form clinical questions and retrieve evidence to advance patient care.”³ The competencies proposed by Albarqouni and colleagues can clearly be mapped to this EPA, but the relative importance of each competency and integration into the broader picture is yet to be determined. In a similar fashion, the Accreditation Council for Graduate Medical Education has incorporated evidence-based medicine into its milestone competency framework. Milestone 15, which is under the competency of practice-based learning, states that the learner should “learn and improve at the point of care.”⁴

Another unique feature of this article is the interprofessional nature of the Delphi survey and the consensus meeting (41.0% physicians, 12.5% nurses, and 38.9% allied health professionals in the second Delphi round). In fact, the nursing profession provided the initial attempt to define EBP competencies. Evidence-based practice should not be siloed in each discipline; instead, health professionals should understand how other disciplines use EBP in clinical care. In 2011, the Interprofessional Educational Collaborative proposed core competencies for interprofessional practice, highlighting teamwork, communication, mutual respect, and shared values. To maximize success, medical educators should look for methods that integrate the proposed EBP competencies into interprofessional education using this framework.⁵

Efforts to define the most valued competencies and EPAs need to focus on those skills and behaviors most likely to improve patient outcomes. In EBP, the greatest yield seems to be in the domain labeled apply in this study. Health care professionals with the ability to access the latest medical evidence will be ineffective if they cannot communicate evidence to patients and individualize the approach based on patient preferences. Shared decision making, as identified in this study, is just one opportunity to improve patient outcomes.⁶ Better patient understanding of the medical evidence or the desired outcomes may improve patient trust and adherence to the clinician’s recommendations. To affect patient outcomes, EBP and its competencies will need to adapt to a changing health care delivery system with increasing use of health information technology.

Evidence-based practice, in contrast to the older term evidence-based medicine, implies daily incorporation of medical evidence in real-time clinical practice. This challenge requires the health care professional to create a sustainable system to obtain new literature, critically assess its value, and apply it to individual patients. In a sense, this commitment to the EBP standard is the EPA our learners should achieve. Although these competencies provide a framework, the pedagogy to meet this goal remains a challenge. Real-time EBP learning tied to patient care (in the clinics, on rounds) is more effective than journal clubs and group didactics, which create a temporal and physical space between the evidence and the patient.^7,8 Learners must have the opportunity to practice these skills over time and receive feedback on their performance. The transition of these competencies into the clinical years allows the application and evaluation of EBP in the context of care delivery until it is a natural and integral part of a clinician’s practice style.

Health care delivery models have evolved from a traditional physician and patient care model to team-based care with interdisciplinary integration. With a common list of competencies, early interprofessional education can ensure a standardization of EBP between members of different professions, ensuring high-quality, evidence-based care. However, EBP within each profession will not automatically enable effective communication between disciplines. One can imagine a new set of competencies that could help bridge this gap.

Albarqouni and colleagues have provided a solid foundation for health profession educators to improve our educational programs in evidence-based practice. Future efforts can focus on incorporating these competencies into EPAs, defining best practices to encourage EBP in the interprofessional team, and creating systems to promote lifelong self-directed learning. In the end, using EBP to improve patient outcomes should be the goal of all educators and trainees.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2018 Nandiwada DR et al. JAMA Network Open.

Corresponding Author: Deepa Rani Nandiwada, MD, MS, Penn Center for Primary Care, University of Pennsylvania Perelman School of Medicine, 51 N 39th St, MAB 102, Philadelphia, PA 19104 (deepa.nandiwada@uphs.upenn.edu).

Conflict of Interest Disclosures: None reported.