Impact of Educational Interventions on Evidence-Based Medicine Skills: A Systematic Review of Fresno Test Outcomes in Residents and General Practitioners (Preprint)

BACKGROUND While Evidence-Based Medicine (EBM) is a fundamental pillar of modern healthcare, its implementation into general practice is often hindered by time constraints, resource deficits, and the inherent complexity of primary care. This challenge is further exacerbated by a lack of consensus on EBM instruction, highlighting a critical need for standardized educational frameworks. OBJECTIVE To systematically synthesize intervention studies evaluating the effectiveness of EBM training, including EBM skills, and the impact of EBM on reactions, behavioral changes, attitudes, and practices among general practitioners and residents in family medicine. METHODS We conducted a systematic synthesis of interventional studies that used the Fresno test to assess EBM skills among residents or general practitioners after educational interventions (lectures, workshops, journal clubs, or e-learning program). A comprehensive search was performed across the Cochrane Library, Embase, and Medline databases for records published between January 1980 and July 2025. Study quality was assessed using the Modified Medical Education Research Study Quality Instrument (MMERSQI), and risk of bias was evaluaAmong the 200 records screened, eight studies involving 431 participants (residents and general practitioners) met the inclusion criteria. Study designs included one randomized controlled trial, six before–after studies, and one cross-sectional study. Mean methodological quality (MMERSQI) was 65.3 (SD 7.2). One study had a low risk of bias, five had a moderate risk, and two were rated as presenting with a high risk of bias, mainly due to confounding factors and selection into analysis. Six studies reported significant improvement in Fresno test scores after training, with mean score increases ranging from 4% to 60% (p