原著
薬局薬剤師を対象とした継続的なEBM教育プログラムが薬剤師業務に与える影響
2019 年 3 巻 論文ID: 2019-003
詳細
2019 年 3 巻 論文ID: 2019-003
近年，Evidence-based Medicine（EBM）の実践とその教育の重要性が高まっている．本研究の目的は9ヶ月間に渡るEBM学習プログラムを通じて受講生である薬剤師にもたらされた教育効果を明らかにすることである．2016年4月から12月まで毎月1回，23名の希望者を対象にEBMの実践に必要な知識と技能を学習するためのワークショップ形式の研修会を開催した．EBMの実践に関する自己評価を，研究開始時，研修中，研修終了時および研修後の計4回実施して比較検討した．研修開始後の総学習時間に変化はないが，医学文献の閲覧時間は増加した．EBM教育を受けることで，医学文献に対する抵抗感が緩和されたものと考えられる．さらに，日常業務での疑義照会や処方提案の場面で，エビデンスを共有し意志決定する試みを経験していた．研修終了後も，EBMの実践に必要な知識と技能を維持していることが明らかとなった．
Evidence-based medicine (EBM) is a systematic approach to clinical problem-solving that allows clinical expertise to be integrated with the best available research evidence, as well as patients’ preferences, actions, clinical status, and circumstances. Ideally, EBM is carried out in five essential steps: formulating the clinical questions (CQs) (Step 1); searching for the best evidence (Step 2); critically appraising the evidence (Step 3); incorporating evidence into decision-making (Step 4); and evaluating the process (Step 5)1).
Pharmacists who work in medical settings have not had the opportunity to receive sufficient EBM education. To overcome this situation, journal clubs, workshops, and information-sharing using information and communication technology have attracted attention2–4). However, the continuity of the learning effects is an important issue4). Based on the results of a survey in 2015, EBM education was implemented in 88% of all 6-year pharmacy departments in Japan5). However, the teachers pointed out that there were many problems involving skills and the environment in current EBM education, for example, statistics and English serving as barriers, a lack of cooperation among academic disciplines, a lack of experience in practice at medical sites, and a shortage of time for education. Although the students who were actually learning EBM understood the importance of EBM practice, they also felt that the lack of training time and opportunities for practice were major problems6).
Pharmacists can gain clinical knowledge after graduation. Therefore, environmental improvements, such as the existence of leaders who are familiar with EBM practices, are required in postgraduate EBM education. The practice reported by Nakagawa, which was to create the appropriate environment for EBM education in the workplace, was an excellent activitiy2). A systematic review found that postgraduate EBM education was effective for acquiring skills and knowledge, but whether this leads to the practice of EBM has not been clarified7).
In the present research, we planned a monthly EBM learning program based on workshops and provided participants with a total of 36 hours of training in EBM practice. We then examined self-assessed behavioral changes among the program participants using two types of questionnaires: one to evaluate changes in the attitude necessary for EBM practice, and the other to evaluate the acquisition of knowledge regarding EBM.
We planned a course as an EBM learning program for pharmacists who engaged mainly in dispensing prescriptions in community pharmacies that was to be held once a month for 9 months (April 2016 to December 2016). Each meeting was a 4-hour session on a Sunday afternoon, with a plenary session led by a physician and a hospital pharmacist who were familiar with the practice of EBM, and group discussions led by four pharmacists who had received sufficient training for EBM education as facilitators.
The learning theme of each meeting was as follows: (first) how to listen to briefings provided by pharmaceutical companies; (second) critical appraisal of research papers involving randomized clinical trials (RCTs); (third) critical appraisal of systematic reviews (SRs); (fourth) critical appraisal of clinical practice guidelines; (fifth) critical appraisal of medical information; (sixth) intensive training of Step 1 among the five essential steps of EBM; (seventh) intensive training of Step 2; (eighth) intensive training of Step 4; and (ninth) problem-solving to practice EBM.
The first to fifth meetings were regarded as the “education program”, and the sixth to the ninth as the “learning program”. In the “education program”, intensive training in Step 3 among the five essential steps of EBM was conducted using “Sheets for Critically Appraised Topics” and “Beginners’ Training Sheets for Critical Appraisal” devised by one of the authors8). The main purpose of this program was to enable the participants to acquire basic knowledge. During this program, the participants used common scenarios and published articles for critical appraisal training. The themes in the scenarios and published articles are shown in the Appendix 1. These materials were distributed before each meeting, and the participants were required to carry out the preliminary tasks.
In the “learning program”, participants themselves prepared the scenarios and published articles before each meeting, and received continuous training from Step 1 to Step 4. After sharing the results of their preliminary tasks in the group, the participants completed the report in response to feedback from the facilitators. In the final meeting, the participants held a group discussion on the subject of EBM practice.
2. Research participantsThe participants in our research were applicants of the workshop organized by Social University (SU; a general incorporated association in Tokyo)9). SU is an organization that conducts projects aimed at developing human resources through learning for medical professionals and people working in the medical setting. The inclusion criteria for the participants were as follows: (i) to be able to attend all nine meetings for EBM learning; (ii) working as a pharmacist in a medical field; and (iii) willing to give consent to participate in our research.
At the first meeting, we informed the applicants that we were planning to conduct questionnaire surveys for research purposes from the second meeting. After obtaining approval for the research implementation, informed consent forms and the questionnaire surveys were distributed.
3. Attendance rate, comprehension score, and self-assessment surveysThe participants’ attendance rate and self-assessed comprehension scores (0–100) were recorded at every meeting. The participants were required to respond to two types of self-assessment questionnaire surveys regarding the practice of EBM and the understanding of technical terms. The survey was conducted at four time points: a baseline survey (April 2016), an interim survey (August 2016), a final survey (December 2016), and a follow-up survey (March 2017).
4. Outcome measurementsThe primary outcome was the change in behavior of the participants in regard to the practice of EBM. Thus, we asked the participants to answer the following three categories of questions: 1) the frequency of reading published research papers; 2) the frequency of carrying out the five essential steps of EBM to provide more advanced pharmaceutical care in their daily work; and 3) the frequency of making pharmaceutical inquiries regarding prescriptions to the prescriber, known as gigi-syoukai in Japanese.
To evaluate the frequency of reading published research papers, we examined the number of participants who had actually read published articles involving clinical trials, RCTs, meta-analyses, and SRs, regardless of language, and the total time spent reading published articles and carrying out self-learning. To assess their motivation for the continuous practice of EBM, we also investigated how many participants had participated in another EBM education program. To evaluate the frequency of practicing EBM steps in pharmaceutical care during daily work, we examined how many participants had consciously applied EBM Steps 1 through 3. The behavioral changes of the participants in pharmaceutical inquiries about prescriptions to prescribers were evaluated by assessing how many participants had made pharmaceutical inquiries, how many participants had presented clinically important proposals about medical therapy with/without evidence from research papers, and the number of occurrences per month of these activities for each participant. To assess the improvement in quality, the following three total proposals regarding EBM practice were evaluated: 1) total proportion of proposals for all inquiries; 2) those accepted with prescribers; and 3) those accepted with evidence.
The secondary outcome was the participants’ understanding of technical terms related to EBM, which was investigated by self-assessment with 200 total possible points for 50 terms (scored from 0 to 4, with 4 indicating the best understanding). The 50 terms used for this survey are shown in Appendix 2. We calculated the total score for each participant in each survey, and then constructed a box plot of all participants. The percentage of the total number was obtained by dividing the total number of technical terms for which a score from 0 to 4 was obtained by 50 times the number of respondents.
5. Statistical analysisAll statistical analyses were performed using EZR10). Categorical variables were compared using Fisher’s exact test, and continuous variables were compared using a t-test. All tests were two-sided, and significance was set at 5%. Significant differences between the two groups were tested mainly between the baseline and final, or between the baseline and follow-up surveys.
6. Ethical considerationsWe notified the survey respondents that we would use the survey results for analysis and intended publication. We informed the participants that returning a completed survey would be taken as consent to participate. This research was approved by the Clinical Education and Research Ethics Committee of Social University (approval number; SU-0003, approval date; April 28, 2016).
In total, 23 pharmacists applied to our learning program, and all pharmacists agreed to participate in our research. The participants’ background information is summarized in Table 1. Among the 23 pharmacists, 17 (73.9%) were working in a community pharmacy and six (26.1%) in a hospital. Seventeen (73.9%) of the pharmacists had graduated from a 4-year pharmacy program in Japan, and six (26.1%) had graduated from a 6-year program. Eleven participants (47.8%) were receiving EBM education for the first time. Among all the pharmacists who had graduated from a 4-year program, 13 (76.5%) had not had a previous opportunity to receive EBM education, whereas four pharmacists (66.7%) who had graduated from a 6-year program had previously had the opportunity to learn EBM as part of their undergraduate curriculum. All six pharmacists working in a hospital had previous experience with EBM education, compared with only three (17.6%) of those working in a community pharmacy.
| Survey | Baseline, Interim | Final | Follow-up |
|---|---|---|---|
| Total number of participants | 23 | 19 [–4] | 15 [–8] |
| Age, years | |||
| 20–29 | 8 (34.8) | 8 | 6 [–2] |
| 30–39 | 9 (39.1) | 7 [–2] | 6 [–3] |
| 40–49 | 4 (17.4) | 3 [–1] | 3 [–1] |
| 50–59 | 2 (8.7) | 1 [–1] | 0 [–2] |
| Workplace | |||
| Community pharmacy | 17 (73.9) | 13 [–4] | 9 [–8] |
| Hospital | 6 (26.1) | 6 | 6 |
| Education | |||
| Graduated from a 4-year program | 17 (73.9) | 13 [–4] | 11 [–6] |
| BS | 12 (52.7) | 8 [–4] | 9 [–3] |
| MS | 4 (17.4) | 4 | 1 [–3] |
| PhD | 1 (4.3) | 1 | 1 |
| Graduated from a 6-year program | 6 (26.1) | 6 | 4 [–2] |
| Previous EBM education | |||
| None | 11 (47.8) | 8 [–3] | 6 [–5] |
| Yes | 12 (52.2) | 11 [–1] | 9 [–3] |
| Undergraduate | 8 (34.8) | 7 [–1] | 5 [–3] |
| Postgraduate | 9 (39.1) | 8 [–1] | 8 [–1] |
EBM: evidence-based medicine. Data in the baseline, interim column are expressed as n (%), and those in the final and follow-up column are n [decreased number from baseline survey].
The mean attendance rate was 84.4 ± 7.9% (Table 2). The collection rate was 100% for both the baseline survey and the next interim survey; however, the collection rate fell to 82.6% for the final survey and to 65.2% for the follow-up survey.
| Meeting theme | Attendance n (%) |
Comprehension score (mean ± SD) |
Education | Previous EBM education | ||
|---|---|---|---|---|---|---|
| 4-year (mean ± SD) |
6-year (mean ± SD) |
No (mean ± SD) |
Yes (mean ± SD) |
|||
| Education program (basic) | ||||||
| 1 Medical information (1) | 22 (100.0)* | 65.5 ± 21.1 | 69.7 ± 18.0 | 65.8 ± 8.0 | 66.8 ± 19.3 | 70.0 ± 13.0 |
| 2 Critical appraisal of RCTs | 19 (86.4)* | 67.6 ± 18.0 | 64.2 ± 19.1 | 75.0 ± 13.8 | 59.4 ± 20.8 | 73.6 ± 13.6 |
| 3 Critical appraisal of SRs | 19 (82.6) | 65.2 ± 19.5 | 61.1 ± 16.2 | 74.1 ± 24.6 | 49.3 ± 17.1 | 76.8 ± 11.5‡ |
| 4 Critical appraisal of CPGs | 19 (82.6) | 68.3 ± 21.9 | 70.9 ± 15.0 | 75.0 ± 13.4 | 70.0 ± 11.0 | 73.6 ± 16.0 |
| 5 Medical information (2) | 18 (78.3) | 75.6 ± 14.6 | 75.8 ± 13.1 | 75.0 ± 20.8 | 80.0 ± 12.6 | 73.0 ± 15.7 |
| Learning program (advanced) | ||||||
| 6 Training of Step 1 | 21 (91.3) | 72.0 ± 17.7 | 67.9 ± 18.9 | 81.7 ± 10.3 | 66.5 ± 14.7 | 77.5 ± 19.5 |
| 7 Training of Step 2 | 17 (73.9) | 75.0 ± 15.3 | 69.1 ± 15.0 | 85.3 ± 9.2† | 69.3 ± 19.7 | 79.0 ± 10.7 |
| 8 Training of Step 4 | 18 (78.3) | 72.5 ± 8.6 | 69.6 ± 7.8 | 80.0 ± 6.1 | 67.5 ± 7.1 | 76.5 ± 7.8‡ |
| 9 Conclusion | 20 (87.0) | 82.2 ± 10.7 | 81.7 ± 11.1 | 83.3 ± 10.8 | 80.0 ± 13.1 | 84.0 ± 8.8 |
| Total | 84.4 ± 7.9 | 71.3 ± 17.5 | 70.0 ± 18.8 | 75.1 ± 12.3 | 65.2 ± 20.4 | 75.8 ± 13.4 |
RCT: randomized controlled trial, SR: systematic review, CPG: clinical practice guideline, SD: standard deviation, EBM: evidence-based medicine. *One of the participants attended from the third meeting, thus, only his baseline survey was conducted retrospectively in June 2016. †There were no statistically significant differences between the two education groups except for the seventh meeting (p = 0.025). ‡There were no statistically significant differences between the two previous EBM education groups except for the third meeting (p < 0.001) and eighth meeting (p = 0.002).
Table 2 also shows the results regarding the participants’ self-assessed comprehension score. The mean score was 71.3 ± 17.5, which was significantly higher at the final compared with the first meeting (82.2 vs. 65.5, respectively; p = 0.004). As a result of the stratified analysis by academic background and EBM education, comprehension scores were significantly different in the third, seventh, and eighth meetings. In the seventh meeting (training of Step 2), the mean comprehension score was significantly higher among participants who had graduated from a 6- compared with a 4-year program (85.3 vs. 69.1, respectively; p = 0.025). The mean comprehension score of the participants who had experienced EBM education was significantly higher than that of participants who had not (76.8 vs. 49.3, respectively; p < 0.001) in the third meeting (critical appraisal of SRs). In the eighth meeting (training of Step 4), a significant difference was also found in EBM education (76.5 vs. 67.5, respectively; p = 0.022).
3. Primary outcome 1) Frequency of reading published research papersTable 3 shows the results regarding the primary outcome. The percentage of participants who had read research papers in the last month of each stage of the survey increased from 39.1% at baseline to 69.6% at the interim, 78.8% at the final (p = 0.013), and 93.3% at the follow-up (p = 0.001) surveys, respectively. The mean total time spent reading research papers about clinical trials also increased from 0.3 to 1.1, 3.0 (p = 0.033), and 4.7 hours per month (p = 0.004), respectively. No significant increases were seen in the mean total time of self-learning in each stage of the survey.
| Survey | Baseline | Interim | Final | p | Follow-up | p |
|---|---|---|---|---|---|---|
| n | 23 | 23 | 19 | 15 | ||
| 1. Frequency of reading published research papers on clinical trials for pharmaceuticals | ||||||
| Number who read papers (%) | 39.1 | 69.6 | 78.9 | 0.013 | 93.3 | 0.001 |
| Mean time of reading papers (h) | 0.3 ± 1.1 | 1.1 ± 2.2 | 3.0 ± 5.8 | 0.033 | 4.7 ± 6.8 | 0.004 |
| Mean time of self-learning (h) | 16.9 ± 16.3 | 17.1 ± 13.7 | 21.1 ± 14.6 | 0.389 | 23.5 ± 16.4 | 0.234 |
| Number who took part in another EBM program (%) | 26.1 | 34.8 | 31.6 | 0.516 | 66.7 | 0.020 |
| 2. Frequency of practicing EBM steps in pharmaceutical care during daily work | ||||||
| Number who practiced Step 1 (%) | 21.7 | 39.1 | 78.9 | 0.000 | 66.7 | 0.008 |
| Number who practiced Step 2 (%) | 13.0 | 39.1 | 68.4 | 0.000 | 66.7 | 0.001 |
| Number who practiced Step 3 (%) | 0.0 | 13.0 | 31.6 | 0.005 | 40.0 | 0.001 |
| 3. Frequency of pharmaceutical inquiries to prescribers regarding prescriptions | ||||||
| Number who made pharmaceutical inquiries (%) | 95.7 | 87.0 | 94.7 | 1.000 | 86.7 | 0.550 |
| Number who proposed medication (%) | 82.6 | 78.3 | 73.7 | 0.707 | 80.0 | 1.000 |
| Number who proposed with evidence (%) | 39.1 | 34.7 | 47.4 | 0.756 | 53.3 | 0.509 |
| Mean number of pharmaceutical inquiries (cases) | 21.8 ± 17.1 | 17.4 ± 15.4 | 15.9 ± 12.3 | 0.221 | 21.9 ± 16.2 | 0.997 |
| Mean number of proposals about medication (cases) | 4.5 ± 4.5 | 4.3 ± 6.4 | 5.7 ± 8.2 | 0.563 | 8.5 ± 8.6 | 0.069 |
| Mean number of proposals with evidence (cases) | 1.3 ± 2.5 | 1.4 ± 2.9 | 0.9 ± 1.3 | 0.528 | 1.8 ± 2.5 | 0.559 |
EBM: evidence-based medicine.
The percentage of participants who practiced any Step 1 through 3 significantly increased throughout the EBM learning program. The percentage of participants practicing Step 1 (to formulate CQs using the patient-intervention-comparison-outcome [PICO] model) was increased from 21.7% to 78.9% at the final survey, while that practicing Step 2 (to search for medical information using PICO) increased from 13.0% to 39.1%, 68.4% (p < 0.001), and 66.7% (p = 0.001), respectively. No participant put Step 3 (to appraise research papers critically) into practice at the baseline survey, but this increased to 13.0%, 31.6% (p = 0.005), and 40.0% (p = 0.001).
3) Frequency of pharmaceutical inquiries to prescribersNo significant differences were seen in the percentage of participants who made pharmaceutical inquiries regarding prescriptions to prescribers or who proposed alternative medication corresponding to these pharmaceutical inquiries throughout the survey period. The number of participants who proposed the medication with evidence increased throughout the study period, from 39.1% at the baseline survey to 53.3% at the follow-up survey (p = 0.509).
4) Change in clinical queries for pharmaceutical inquiriesThe total proportion of the number of medical proposals to pharmaceutical inquiries to prescribers, shown in Figure 1, increased significantly, from 20% to 35.6% at the final survey (p < 0.001) and to 41.7% at the follow-up survey 3 months later (p < 0.001). The overall proportion of accepted cases to the above-mentioned medical proposals significantly increased, from 60.6% to 75.0% (p = 0.027) at the final survey.
Changes in clinical queries for pharmaceutical inquiries regarding prescriptions to the prescriber. ● shows the total proportion of proposals for all inquiries; □ shows those accepted with prescribers, and ■ shows those accepted with evidence.
The participants’ comprehension of technical terms related to EBM practice at baseline varied widely. The mean score at each stage of the survey increased from 61.2 to 125.5, 155.2, and 157.7, respectively, while the median increased from 42 to 120, 153, and 149, respectively (Fig. 2A). No significant differences were seen in the mean scores of the dropouts at baseline (p = 0.212, 0.348). The percentage of those choosing the 0-points option, meaning “no comprehension at all”, decreased from 42.9% at baseline to 7.7% at the next interim survey (Fig. 2B), while the percentage of those choosing the 4-point option, meaning “can explain to other people”, increased from 20.4% at the interim survey to 40.3% at the final survey. At follow-up (3 months after the final meeting of our program), no decline in comprehension was observed. In total, there were 22 technical terms for which more than 11 people chose the 0-points option at baseline, including “intention to treat (ITT) analysis”, “funnel plots”, “forest plots”, “four elements of application”, “Cochrane collaborations”, and “clinical queries”.
Time-dependent changes in the knowledge of technical terms related to the practice of evidence-based medicine (EBM). (A) Box plot evaluation of the total points obtained by 50 technical terms for each participant. The × indicates the mean value. (B) Percentage component bar chart of the entire score for each survey. (A and B) The options actually provided were as follows: 0 pts., no comprehension at all (mattaku-shira-nai); 1 pt., no comprehension, but I have heard of it (kiita-koto-aru); 2 pts., insufficient comprehension (nannto-naku shitte-iru); 3 pts., sufficient comprehension, but not explainable to other people (rikaishite-iru ga setumei deki-nai); and 4 pts., sufficient comprehension and explainable to other people (setumei ga dekiru).
The results of the present research revealed that our monthly EBM learning program enhanced participants’ knowledge of EBM skills (Fig. 2) and ability to make pharmaceutical inquiries to prescribers regarding prescriptions (Table 3); these results persisted at 3 months after the final training day, suggesting that the participants’ behavior as pharmacists changed to allow them to intervene in more complicated cases and clinical problems (Fig. 1).
During the 9-month program, the number of participants who read clinical literature increased, and this habit continued after the program. No change in self-learning time was observed (Table 3). On the other hand, time spent reading clinical papers increased. Therefore, it is thought that most of the self-learning time changed to time spent reading the clinical literature. The purpose of reading research papers became clearer, which alleviated the participants’ resistance to this task. Nakagawa et al. reported that instilling the habit of reading clinical papers through journal clubs allowed the participants to change their mind and realize that they could make prescription proposals2). In this research, we investigated behavior changes in daily work as a pharmacist. The percentage of those who used the five steps of EBM practice increased significantly compared with the beginning of the training (Table 3).
Although no change was seen in the number of pharmaceutical inquiries per month for the participants in this research, the proportion of proposals for inquiries was significantly increased (shown as ● in Fig. 1). In pharmasists’ daily work, many pharmaceutical inquiries were not directly related to the practice of EBM, and about 15% of cases were related to formal prescription defects12). In addition, the percentage of proposals for pharmaceutical inquiries to prescribers was low (20.8%); however, after the training, this percentage was significantly increased (41.7%). This result indicates that the participants’ pharmaceutical inquiries were made because of decision-making regarding clinical problems.
The acceptance rate of proposals was significantly increased at the end of training; however, this increase disappeared by follow-up. The increase in proportion of proposals may have been due to the increase in more complicated cases. Although only a few proposals with evidence obtained from the clinical literatures have been carried out, the acceptance rate was still over 80% (Fig. 1). Therefore, a future task is to increase the number of proposals with critically appraised evidence by studying the literature and practicing the five steps of EBM.
The establishment of learning effects is an important issue. The level of understanding of technical terms in EBM practice, which was a secondary outcome, did not change after 3 months (Fig. 2). Through journal clubs3), the degree of basic knowledge decreased after 1 month. These differences were considered to be due to the fact that this was a monthly program, and that many clinical documents were read during the participants’ self-learning time.
Half of the participants had not received any EBM education. There were few absentees and dropouts, and their comprehensive scores slightly increased toward the final meeting. The monthly program was considered to be very useful as it could lead to the improvement of the EBM practice environment, namely the lack of training and practice opportunities.
EBM education workshops are an excellent way to learn while answering questions based on rich experiences in the medical field. However, for pharmacists with insufficient EBM education, it is not easy to eliminate the lack of education time and training in a single workshop. Our program consists of an educational program to understand the concepts and procedures of EBM practice, and a learning program that gives direct advice on practicing Step 4 in specific scenarios. Therefore, it is considered that the participants could step up without difficulty.
At the baseline survey, many of the participants did not know terms related to statistical analysis such as “ITT analysis”, “α errors”, “β errors”, and “forest plots”. However, it has been reported that only about 7 hours of education is needed to master the technical terms necessary to read clinical trials11). Regarding the comprehension scores at the seventh meeting, where intensive training for Step 2 (information gathering) was carried out, the mean for participants who had graduated from a 4-year program was low. At the baseline survey, half of the participants had no knowledge of medical subject headings (MeSH), the Cochrane library, Minds, or clinical practice guidelines. It is difficult to collect useful information efficiently using only free services such as PubMed; therefore, to improve postgraduate EBM education, it will be necessary to prepare an environment in which useful services, including pay sites, can be utilized.
Many pharmacists do not have a habit of reading published research papers dealing with RCTs that were implemented for pharmaceutical drug approval. In the second meeting focusing on training for critical appraisals of RCTs, no difference in comprehension was seen between community pharmacy and hospital pharmacists; however, a difference was observed at the third meeting regarding critical appraisals of SRs. One possible explanation for this difference is the differences in experience reading papers on RCTs. To utilize the results of SRs, it is necessary to understand each RCT that has been integrated into the meta-analyses. As a result of the large difference in regard to comprehension of SRs, four alternative training sessions focusing on SRs were held after the completion of scheduled training; seven community pharmacists and four hospital pharmacists participated.
The present research had some limitations. First, the evaluations of our EBM learning program used self-assessment questionnaires; thus, the results may have been affected by misunderstandings or wrong answers from the participants. Second, as the participants in this research were highly motivated, our results cannot be directly applied to Japanese general pharmacists who engage in mainly prescription dispensing.
Through participating in our monthly EBM learning program, the number of EBM practitioners increased. The results obtained in this research suggest that learning technical terms related to EBM, acquiring methods for considering the appropriate application of EBM to patients, and practicing pharmaceutical care are effective for the practice of EBM in the medical setting. Therefore, developing effective EBM programs for pharmacists and preparing an environment suitable for such programs are needed in order to practice EBM in medical settings such as hospitals, clinics, nursing homes, care homes, and pharmacies.
The authors Kurata, Igarashi, and Nango received a reward from Social University as workshop instructors. The author Dobashi is an unpaid senior researcher at Social University.
The reference materials for carrying out the workshop are summarized in Tables S1 and S2. These supplementary materials will be included in the J-STAGE online version of The Journal.
