Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. 91, No. 1 / January 2016 101 Research Report In the last 20 years, evidence-based medicine (EBM) has become a standard component of the medical school curriculum. 1 Despite this ubiquitous inclusion, physicians’ practice of EBM is suboptimal, 2–4 which has implications for patient safety, cost-effectiveness, and consistency of care. 5,6 The suboptimal practice of EBM has prompted researchers to explore challenges to physicians practicing, clinician educators teaching, and students learning EBM. In research on barriers to practicing EBM in clinical settings, the challenges reported by physicians have included a lack of time, conflicts between evidence-based recommendations and patient preferences, and weak available evidence. 4,7,8 Additionally, EBM instructors have described barriers to teaching EBM in clinical care. These barriers include a lack of time for teaching EBM, an absence of EBM requirements for trainees, and their own, as well as trainees’, lack of EBM knowledge and skills. 8 On the basis of these studies, researchers have suggested that the challenges reported by physicians and EBM instructors be considered when designing EBM curricula, as they may have implications for student learning. For example, if physicians are challenged by time constraints and fail to practice EBM, then students may have limited exposure to optimal EBM role models, which could impact their learning experiences. Although research on these barriers may inform student training, it does not directly examine the challenges medical students may face when learning EBM, which may differ and contribute to the suboptimal practice of EBM. Research on challenges to students learning EBM is limited and focused on training in clerkship settings. For example, two studies found that the challenges to learning EBM in clerkships included receiving minimal support from clinical teachers for using EBM and limited opportunities for practicing EBM. 9,10 Knowledge of the EBM learning challenges faced in clerkships is important but narrow in scope, as EBM training can be offered across all years of medical school. 11 Researchers have also studied barriers that faculty perceive in implementing EBM curricula. 12–14 However, these studies focus on barriers to the delivery of EBM curricula such as lack of curricular time. 13 Our study aims to identify learner- centered challenges that medical students face across medical schools when learning EBM. With these challenges identified, we then explore potential solutions by examining the educational approaches used by medical schools to overcome them. Thus, our study aims to identify Abstract Purpose Evidence-based medicine (EBM) is a fixture in many medical school curricula. Yet, little is known about the challenges medical students face in learning EBM or the educational approaches that medical schools use to overcome these challenges. Method A qualitative multi-institutional case study was conducted between December 2013 and July 2014. On the basis of the Association of American Medical Colleges 2012 Medical School Graduation Questionnaire data, the authors selected 22 U.S. and Canadian Liaison Committee on Medical Education–accredited medical schools with graduates reporting confidence in their EBM skills. Participants were interviewed and asked to submit EBM curricular materials. Interviews were audio-recorded, transcribed, and analyzed using an inductive approach. Results Thirty-one EBM instructors (17 clinicians, 11 librarians, 2 educationalists, and 1 epidemiologist) were interviewed from 17 medical schools (13 in the United States, 4 in Canada). Four common EBM learning challenges were identified: suboptimal role models, students’ lack of willingness to admit uncertainty, a lack of clinical context, and students’ difficulty mastering EBM skills. Five educational approaches to these challenges that were common across the participating institutions were identified: integrating EBM with other courses and content, incorporating clinical content into EBM training, EBM faculty development, EBM whole-task exercises, and longitudinal integration of EBM. Conclusions The identification of these four learner- centered EBM challenges expands on the literature on challenges in teaching and practicing EBM, and the identification of these five educational approaches provides medical educators with potential strategies to inform the design of EBM curricula. Acad Med. 2016;91:101–106. First published online July 21, 2015 doi: 10.1097/ACM.0000000000000814 Please see the end of this article for information about the authors. Correspondence should be addressed to Lauren A. Maggio, Stanford University School of Medicine, 300 Pasteur Dr., Room L-109, Stanford, CA 94305; telephone: (650) 725-5493; e-mail: lmaggio@ stanford.edu. Challenges to Learning Evidence-Based Medicine and Educational Approaches to Meet These Challenges: A Qualitative Study of Selected EBM Curricula in U.S. and Canadian Medical Schools Lauren A. Maggio, MS(LIS), Olle ten Cate, PhD, H. Carrie Chen, MD, MSEd, David M. Irby, PhD, and Bridget C. O’Brien, PhD