Open Access Highly Accessed Research article

Harmonising Evidence-based medicine teaching: a study of the outcomes of e-learning in five European countries

Regina Kulier1*, Julie Hadley2, Susanne Weinbrenner3, Berrit Meyerrose3, Tamas Decsi46, Andrea R Horvath5, Eva Nagy5, Jose I Emparanza6, Sjors FPJ Coppus78, Theodoros N Arvanitis1, Amanda Burls1, Juan B Cabello6, Marcin Kaczor9, Gianni Zanrei10, Karen Pierer11, Katarzyna Stawiarz9, Regina Kunz11, Ben WJ Mol78 and Khalid S Khan12

Author Affiliations

1 The University of Birmingham, Edgbaston, Birmingham B15 2TG, UK

2 Birmingham Women's Hospital, Metchley Park Road, Edgbaston, Birmingham B15 2TG, UK

3 Agency for Quality in Medicine, Weglelystrasse 3, 10623 Berlin, Germany

4 University of Pécs, Department of Paediatrics, József Attila u. 7, Pécs, H-7623, Hungary

5 TUDOR, University of Szeged, Albert Szent-Gyorgyi Medical and Pharmacological Centre, Somogyi Bela ter 1, Szeged, H-6725, Hungary

6 CASPe (CASP Espana), Joaquin Orozco 6, 1°-F, 03006 Alicante, Spain

7 Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands

8 Academic Medical Center, University of Amsterdam, Department of Clinical Epidemiology and Biostatistics, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, The Netherlands

9 CASPolska, 30-347 Krakow, ul. Wadowicka 3, Poland

10 Universitá Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29100 Piacenza, Italy

11 Basel Institute for Clinical Epidemiology, Hebelstrasse 10, CH 4031 Basel, Switzerland

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BMC Medical Education 2008, 8:27  doi:10.1186/1472-6920-8-27

Published: 29 April 2008



We developed and evaluated the outcomes of an e-learning course for evidence based medicine (EBM) training in postgraduate medical education in different languages and settings across five European countries.


We measured changes in knowledge and attitudes with well-developed assessment tools before and after administration of the course. The course consisted of five e-learning modules covering acquisition (formulating a question and search of the literature), appraisal, application and implementation of findings from systematic reviews of therapeutic interventions, each with interactive audio-visual learning materials of 15 to 20 minutes duration. The modules were prepared in English, Spanish, German and Hungarian. The course was delivered to 101 students from different specialties in Germany (psychiatrists), Hungary (mixture of specialties), Spain (general medical practitioners), Switzerland (obstetricians-gynaecologists) and the UK (obstetricians-gynaecologists). We analysed changes in scores across modules and countries.


On average across all countries, knowledge scores significantly improved from pre- to post-course for all five modules (p < 0.001). The improvements in scores were on average 1.87 points (14% of total score) for module 1, 1.81 points (26% of total score) for module 2, 1.9 points (11% of total score) for module 3, 1.9 points (12% of total score) for module 4 and 1.14 points (14% of total score) for module 5. In the country specific analysis, knowledge gain was not significant for module 4 in Spain, Switzerland and the UK, for module 3 in Spain and Switzerland and for module 2 in Spain. Compared to pre-course assessment, after completing the course participants felt more confident that they can assess research evidence and that the healthcare system in their country should have its own programme of research about clinical effectiveness.


E-learning in EBM can be harmonised for effective teaching and learning in different languages, educational settings and clinical specialties, paving the way for development of an international e-EBM course.