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Why Teach and Practice EBM? It is required to be taught by TMC. Outcomes research has documented
that patients who do receive evidence-based therapies have better outcomes than those who don’t.
It may be a more efficient means of remaining current than traditional methods (e.g. journal subscriptions).
A host of developments make EBM more possible than ever.
Putting Skills into Practice
Find evidence supporting one clinical decision made on each of your inpatients.
Find evidence supporting one clinical decision made on one patient per clinic day.
Encourage the students and colleagues you work with to follow your lead.
Work as a team to find evidence-based answers.
What is the intervention? The 5 steps of practising EBHC – but what
is the appropriate dose, formulation and method of delivery? Standing courses Lectures Conferences Journal clubs At the bedside Online Others
Course Structure - 8 week cycleWeek 1• Introduction• Asking a clinical question• Critical appraisal of therapy articles• Therapy questions• Searching
Week 2• Critically appraise therapy
articles• Write CAT• New question and real-time
practice session
Week 3• Review asking a clinical question• Critical appraisal of prognosis
articles• Prognosis questions• Searching
Week 4• Critically appraise prognosis
articles• Write CAT• New question and real-time
practice session
Week 5• Introduction• Asking a clinical question• Critical appraisal of diagnosis
articles• Diagnosis questions• Searching
Week 6• Critically appraise diagnosis
articles• Write CAT• New question and real-time practice
session
Week 7• Review asking a clinical question• Critical appraisal of articles about
harm• Searching
Week 8• Critically appraise harm
articles• Write CAT• New question and real-time
practice session
Think of Therapy ?’s
Think of Prognosis ?’s
Think of Diagnosis ?’s
Think of Harm ?’s
Presentations will cover: 1. search strategy; 2. search results; 3. the validity of this evidence; 4. the importance of this valid evidence; 5. can this valid, important evidence be applied to your patient; 6. your evaluation of this process.
3-part Clinical Question
Patient’s Name Learner:
Target Disorder:
Date and place to be filled:
Intervention (+/- comparison):
Outcome:
Cased-BasedJournal Clubs Case focused Vote on topics Simple appraisal Note further actions
More information Equipment Training etc
H
What are the relevant outcomes? Attitudes
There are several studies that have looked at attitudes towards EBM but little psychometric data available
Self-Directed Learning Readiness Scale can be used to assess readiness and is defined as the ‘degree to which the individual possesses the attitudes, abilities, and personality characteristics necessary for SDL’
What are the relevant outcomes? Knowledge and Skills
Changes in clinicians’ knowledge and skills are relatively easy to detect and demonstrate
Several instruments developed to evaluate these
However, these instruments primarily focus on evaluating skills of clinicians who want to practise in the ‘doing’ mode rather than the ‘using’ mode
What are the relevant outcomes? Behaviours
More difficult to measure because they require assessment in the practice setting
A recent before and after study found that a multi-component EBHC intervention significantly improved evidence-based practice patterns
Clinical Outcomes The most difficult to measure
What are some barriers to teaching EBHC? Time constraints – for teachers and
learners Lack of resources Paucity of evidence that EBHC works
Morning Report
Learners: all members of the medical teams Objectives: briefly review new patient(s) and
discuss/debate diagnostic and management strategies
Evidence of highest relevance: accuracy and precision of physical exams and diagnostic tests, effectiveness and safety of therapy
Strategies: educational prescriptions for foreground questions (CQ log), fact follow-ups for background questions, 1-2 minute summaries of critically appraised topics, add a clinical librarian to the team
Some Tips for Good journal clubs
Use high quality articles relevant to your clinicians
Have clear roles
Use visual aids
Keep a record – paper or intranet
Follow-up decisions – “next actions”
How to choose questions
List possible topics1. From own patients
2. From EBM journals
Vote on best topics
Get best evidence for next journal club
The top 10 successes that we’ve had or seen in teaching EBM Teaching EBM succeeds:
When it centers around real clinical decisions When it focuses on learners’ actual learning
needs When it balances passive with active learning When it connects new knowledge to old When it involves everyone on the team
Top 10 successes Teaching EBM succeeds:
When it matches and takes advantage of, the clinical setting, available time, and other circumstances
When it balances preparedness with opportunism When it makes explicit how to make judgments,
whether about the evidence itself or how to integrate evidence with other knowledge, clinical expertise and patient preferences
When it builds learners’ lifelong learning abilities
Top 10 mistakes we’ve made or see when teaching EBM Teaching EBM fails:
When learning how to do research is emphasised over how to use it
When learning how to do statistics is emphasised over how to interpret them
When teaching EBM is limited to finding flaws in published research
When teaching portrays EBM as substituting research evidence for, rather than adding it to clinical expertise, patient values and circumstances
Top 10 mistakes we’ve made or see when teaching EBM Teaching EBM fails:
When teaching with or about evidence is disconnected from the team’s learning needs about the patient’s illness or their own clinical skills
When teaching occurs at the speed of the teacher’s speech or mouse clicks rather than the pace of the learner’s understanding
When the teacher strives for full educational closure by the end of each session rather than leaving plenty to think about and learn between sessions
Top 10 mistakes we’ve made or see when teaching EBM Teaching EBM fails:
When it humiliates learners for not already knowing the ‘right’ fact or answer
When it bullies learners to decide to act based on fear of others’ authority or power, rather than on authoritative evidence and rational argument
When the amount of teaching exceeds the available time or the learner’s attention