Teaching Research Literacy and Evidence-Based Practice (EBP)
The skills needed for research literacy and EBP have been traditionally taught in medical education as stand-alone courses or workshops. However, knowledge was better retained or translated to practice when the learning was integrated into clinical settings rather than taught in traditional settings (Coomarasamy and Kahn 2004).
Early educational programs in MT research literacy also focused on stand-alone classes and workshops, principally on critical appraisal techniques, with no direct requirement to apply these skills directly in the clinical setting. In one of the first online research-literacy courses for massage therapists, learners showed significant gains in their knowledge of research-literacy skills and improved attitudes towards evidence-informed practice (Achilles and Dryden 2002). Little is known, however, concerning learners’ long-term retention of that knowledge, application of the skills to practice, or increased use of EBP.
Among medical professions, studies on teaching that integrated EBP into clinical settings in real time, which includes asking answerable clinical questions or going online to find the evidence and applying it to immediate practice or treatment planning, support the usefulness of these kinds of interventions for improvements in skills, attitudes, and behavior. Stand-alone courses are equally effective for improving knowledge, but not skills, attitudes, and behavior (Coomarasamy and Kahn 2004). Clearly, it is important to integrate EBP teaching and research-literacy skills into clinical practice.
Consistent with best practices in adult learning, integrating EBP and research literacy into all aspects of MT programs increases the opportunity for real-world, real-time learning and the likelihood of behavioral change in practitioners. In addition, adult learning is best accomplished when it is facilitated through coaching and mentoring (Das, Malick, and Khan 2008). Since MT programs vary widely in terms of requirements for teacher training and supervised clinical work with clients, opportunities for MT students and practitioners to observe exemplary role models using EBP in the clinical setting and to practice the skills for themselves may be rare in many jurisdictions and schools.
In addition, skills acquisition in taking health histories, performing clinical assessments, planning treatments, keeping records, learning about pathophysiology, and assessing treatment outcomes all vary widely in MT programs. Without strong assessment skills and a working knowledge of pathophysiology, integrating EBP into training and practice is a challenge. In order to successfully incorporate real-time EBP activities into their lesson plans, teachers of science and clinical courses will need time and training, as well as access to online journals and databases, professional librarians, and computers in their classrooms, clinics, and labs. However, the ubiquity of smart phones and other personal data devices, along with wireless Internet access and growing numbers of digitally literate students (and one hopes, teachers), are likely to facilitate the incorporation of real-time EBP more easily and economically into diverse MT learning environments than in the past (Higher Ed Café 2010). In one innovative program, research-literacy skills are taught online through the use of a graphic novel. Learners engage in didactic activities that are integrated components of a compelling and futuristic storyline (Atack et al. 2010). Gaming and online case simulation as instructional delivery methods for teaching research literacy and EBP need to be further developed in MT education and evaluated for effectiveness and learner satisfaction.
Access to just-in-time online EBP modules for busy MT professionals will help accelerate the uptake of best evidence to practice (see chapter 20 for information on clinical case reports). The creation of easy-to-access pathways between MT programs and degree-granting postsecondary institutions will enable the cross-training of massage therapists in disciplines such as adult education, research methods, health administration, and specializations in diverse subject areas within the sciences and humanities. As noted earlier, it is anticipated that recent innovations will drive changes in the incorporation of EBP and research literacy at all levels. Utilization of electronic health records systems in MT, including the necessary creation of a coordinated system for reporting adverse events, would rapidly accelerate the kinds of information needed to develop best-practice guidelines and to answer key questions about client safety. To ensure their use by MT students and massage therapists in the field, both at the entry level and throughout their practices, educators, professional associations, and regulatory bodies need to mandate and evaluate competencies in research literacy and EBP through career-long learning and quality-assurance requirements.
More studies are needed to evaluate the effectiveness of EBP education in MT. Kirkpatrick’s hierarchy is a useful tool that can be adapted to evaluating knowledge, attitudes, and behavior, and, ultimately, client outcomes in EBP (table 18.2).