Geist, Shin-Mey Rose, and James Geist
The purpose of this research was to actively engage students in the process of evidence-based practice (EBP) by investigating conflicts between clinical and didactic instruction in oral medicine and examining how the conflicts impact their patients‟ care. Our Oral Medicine course teaches EBP and is designed to enhance students‟ problemsolving capability and clinical judgment based on current available evidence. However, students occasionally receive clinical instruction that is at odds with EBP. These discrepancies allow formulation of a clinical question that must be answered to provide optimal patient treatment. Since the question arises in a clinical setting, the problem becomes relevant to the students and learning becomes more authentic. Third year students documented instances in which clinical instruction in oral medicine-related management deviated from EBP classroom instruction, and then researched the evidence and drew conclusions about best patient management decisions in these cases. Most students (68 of 76 students, or 89.5% of the class) experienced at least one instance of conflicting instruction. Of the 68 reported cases, the areas that exhibited the greatest level of non-evidence based practice included the use of antibiotic prophylaxis (20 cases), use of local anesthetics with vasoconstrictor (19), and alteration of antiplatelet and/or anticoagulant drugs regimens (11). Many students searched these topics to the highest evidence levels including meta-analyses and systematic reviews. Students believed this project positively enhanced their learning experience. We conclude that students gained authentic experience in EBP. The results helped us identify the greatest sources of conflicting instruction. A wider dissemination of evidence-based guidelines and updated information regarding dental management of these medical problems among the faculty is apparently needed to reduce the amount of conflict in instruction. Our goal is that each year will see a decrease in the number and type of non-evidence-based practices.