Background:
Teaching Evidence Based Medicine (EBM) is becoming a priority in the healthcare process. For undergraduates, it has been proved that integrating multiple strategies in teaching EBM yields better results than a single, short-duration strategy. However, there is a lack of evidence on applying EBM educational interventions in low- or middle-income countries (LMICs).

Objectives:
In this study, we aim to evaluate the effectiveness of a multiple strategy peer-taught online course in improving EBM awareness and skills among medical students in two LMICs, Syria and Egypt.
Methods:
We conducted a prospective study with pre- and post-course assessment of 84 medical students in three universities, using the Berlin questionnaire and a set of self-reported questions which studied the students’ EBM knowledge, attitude and competencies. The educational intervention was a peer-taught online course consisting of six sessions (90 minutes each) presented over six weeks, and integrated with assignments, group discussions, and two workshops.

Results:
The mean score of pre- and post-course Berlin tests was 3.5 (95% confidence interval (CI) 2.94 to 4.06) and 5.5 (95% CI 4.74 to 6.26) respectively, increasing by 2 marks (95% CI 1.112 to 2.888; P value < 0.001), which indicates a statistically significant increase in students’ EBM knowledge and skill, similar to a previous expert-taught face-to-face contact course. Self-reported confidences also increased significantly. However, our course did not have a major effect on students’ attitudes toward EBM (1.9% to 10.8%; P value: 0.12 to 0.99).

Conclusions:
In LMICs, multiple-strategy, peer-taught, online courses may be an effective alternative to face-to-face expert-taught courses, especially in the short term.