Teaching evidence-based medicine in low-certainty clinical contexts: a scoping review of undergraduate medical education

Abstract

Background: Evidence-based medicine (EBM) is a core competency in undergraduate medical education and a foundational principle of modern clinical practice. Traditional EBM curricula emphasize critical appraisal of randomized controlled trials and guideline-driven decision-making. However, many real-world clinical decisions occur in contexts where evidence is limited, conflicting, or value-laden, such as rare diseases, emerging therapies, disability care, and complex multimorbidity.

Objective: This scoping review aimed to map the existing literature on how undergraduate medical education addresses the teaching of EBM in low-certainty and value-sensitive clinical contexts, with attention to educational approaches, learning objectives, outcomes, and implementation challenges.

Methods: Following the PRISMA-ScR framework, we systematically searched MEDLINE, Embase, ERIC, PsycINFO, and Scopus from inception to July 2025. Eligible studies described educational interventions, curricula, or assessments focused on teaching EBM to medical students when high-quality evidence is absent, uncertain, or contested. Data were extracted on study characteristics, pedagogical strategies, clinical contexts, learner outcomes, and reported barriers.

Results: Twenty-six studies were included, spanning pre-clinical and clinical phases of undergraduate medical education across North America, Europe, and Australia. Educational approaches included case-based learning, ethics-integrated EBM teaching, narrative and lived-experience integration, simulation, and reflective practice. Four overarching themes emerged: (1) reframing EBM beyond hierarchies of evidence, (2) integrating patient values and lived experience into evidence reasoning, (3) teaching epistemic uncertainty and clinical judgment, and (4) structural and cultural barriers to curricular integration. 

Conclusion: Existing literature suggests that teaching EBM in low-certainty contexts is feasible and valued by learners, but remains inconsistently integrated into undergraduate curricula. Future work should focus on developing standardized competencies, assessment tools, and longitudinal curricula that reflect the realities of evidence uncertainty and value-sensitive care.