Practice Practice Management In Management In

DentistryDentistry

Recognize the basic concepts of quality Recognize the basic concepts of quality assurance and practice management.assurance and practice management.

Prioritize workload and manage personal Prioritize workload and manage personal stress in the frame work of proper stress in the frame work of proper performance and management.performance and management.

Work in collaboration as a member of an Work in collaboration as a member of an interdisciplinary teaminterdisciplinary team

share information and professional share information and professional knowledge with both the patient and other knowledge with both the patient and other professionals, verbally and in writing, professionals, verbally and in writing, including being able to negotiate and give including being able to negotiate and give and receive constructive criticism.and receive constructive criticism.

Recognize and effectively utilize all Recognize and effectively utilize all sources for continuing professional sources for continuing professional development and life-long learning.development and life-long learning.

Adopt a creative attitude in an ethical and Adopt a creative attitude in an ethical and scientific approach.scientific approach.

Self evaluate professional abilities, Self evaluate professional abilities, performance, and progress.performance, and progress.

use contemporary information technology use contemporary information technology for communication, management of for communication, management of information and applications related to information and applications related to health care.health care.

Successful DentistSuccessful Dentist1.1. Establish a practice in a desirable conditionsEstablish a practice in a desirable conditions2.2. Good relationship with the patientsGood relationship with the patients3.3. A happy practice teamA happy practice team4.4. Reasonable income to maintain reasonable Reasonable income to maintain reasonable

living standardliving standard5.5. Abilities & facilities to keep abreast of modern Abilities & facilities to keep abreast of modern

dentistry, both educationally & in equipmentdentistry, both educationally & in equipment6.6. Technically Skilful in dental proceduresTechnically Skilful in dental procedures7.7. Respect timeRespect time8.8. Three As are important in making a successful Three As are important in making a successful

dentist Availability, Affability and Ability. dentist Availability, Affability and Ability. * * Devote his time to caring of patient as a human being Devote his time to caring of patient as a human being

without the pressure of thinking every minute without without the pressure of thinking every minute without the drill in his hand is lost income.the drill in his hand is lost income.

Making The Choice Making The Choice

& & Planning The Planning The

CareerCareer

It is important to love & enjoy the It is important to love & enjoy the pattern of workpattern of work

Typical dentist works at the dental Typical dentist works at the dental chairside, operate on patients restoring chairside, operate on patients restoring teeth, fillings etc..teeth, fillings etc..

Students must be asked if they good Students must be asked if they good with their handswith their hands

All dentist must be able to do adequate All dentist must be able to do adequate treatment at final examination leveltreatment at final examination level

There are different areas of dentistry There are different areas of dentistry we can gain experiences in, and we we can gain experiences in, and we decide which would be suitable to our decide which would be suitable to our temperamenttemperament

Dentist may be employed Dentist may be employed in:in:

Academic ( full time or part-time)Academic ( full time or part-time)1.1. TeachingTeaching2.2. Research Research Hospital (full time or part-time)Hospital (full time or part-time) General dental practiceGeneral dental practice Specialist dental practiceSpecialist dental practice Participant in commercial promotion Participant in commercial promotion Writing (journalism) Writing (journalism) Organizations & management ( WHO) Organizations & management ( WHO) Public relationPublic relation Armed services Armed services

Technique of part-time option to aid Technique of part-time option to aid in decision making.in decision making.

The option of military services is The option of military services is almost a one-way option.almost a one-way option.

Possible ladder of promotion Possible ladder of promotion depending on further trainingdepending on further training

Planning The Planning The Practice Career Practice Career

There are two kinds of doctors; There are two kinds of doctors; those who are primarily interested in those who are primarily interested in disease and those who are primarily disease and those who are primarily interested in peopleinterested in people

There are two kinds of dentists; There are two kinds of dentists; those who are primarily interested in those who are primarily interested in the mechanics of treatment and the mechanics of treatment and those who are interested in peoplethose who are interested in people

For Private PracticeFor Private Practice

CHOOSING A PLACE DEPENDS ON:CHOOSING A PLACE DEPENDS ON: AgeAge RaceRace Social classSocial class CustomCustom Town OR countryTown OR country

* Remember, you can practice at * Remember, you can practice at home !home !

The question of how far away the The question of how far away the place of work will be from home is place of work will be from home is important in term of travelling time important in term of travelling time and emergencies that necessitate and emergencies that necessitate attendance even at weekends.attendance even at weekends.

Malpractice cover is sought, Malpractice cover is sought, especially as a beginner.especially as a beginner.

Payment issues ( fixed salary, Payment issues ( fixed salary, percentage basis) percentage basis)

Special Special Consideration Of Consideration Of

The Woman Dentist The Woman Dentist

Prejudice against women dentists Prejudice against women dentists both on the public & dentists both on the public & dentists themselves DOES exist.themselves DOES exist.

In Sudan intake of new dental In Sudan intake of new dental student approaches equality in student approaches equality in examination results indicating no examination results indicating no superiority in skills of one gender superiority in skills of one gender over another.over another.

Women dentists can do all dental Women dentists can do all dental procedure which were once considered procedure which were once considered to be exclusively carried out by male to be exclusively carried out by male dentist dentist

Many patients, however, question the Many patients, however, question the ability of women to extract a tooth, this ability of women to extract a tooth, this coincide with the view that dentistry is coincide with the view that dentistry is a manual skills in which dentist is a manual skills in which dentist is always operating, while general always operating, while general medicine (for women) is merely medicine (for women) is merely examination and advice. examination and advice.

Another point is the instability or Another point is the instability or interruption in women's career:interruption in women's career:

1.1. She may have to take more days for She may have to take more days for sicknesssickness

2.2. She may leave to have childrenShe may leave to have children

3.3. If married, might find it necessary to If married, might find it necessary to accompany her husband should he accompany her husband should he be transferred in his job to another be transferred in his job to another area. area.

Another prejudice from female Another prejudice from female ancillary staff, secretaries, chairside ancillary staff, secretaries, chairside assistant etc who prefer a male ‘boss’.assistant etc who prefer a male ‘boss’.

Some women solve this problem by Some women solve this problem by taking up dental practice seriously taking up dental practice seriously after child bearing and rearing is over, after child bearing and rearing is over, although it may be a sacrifice to wait although it may be a sacrifice to wait too long before contributing to the too long before contributing to the home, learning late become difficult. home, learning late become difficult.

To overcome this prejudice, To overcome this prejudice, educating the public is important .educating the public is important .

Another means of decreasing this Another means of decreasing this trend is when the male gender is trend is when the male gender is becoming a minoritybecoming a minority

Building up a Building up a sufficient list of sufficient list of

patientspatients

Entering an Entering an existing practiceexisting practice

For a new graduate dentist in private For a new graduate dentist in private clinic, there are two main clinic, there are two main situations:situations:

Working at another's clinicWorking at another's clinic Beginning on his own clinicBeginning on his own clinic

Working at another's Working at another's clinicclinic

It affords a reasonable numbers of It affords a reasonable numbers of patients.patients.

It necessitates a support from the It necessitates a support from the owner’s and put them in the owner’s and put them in the embarrassment of getting rid of embarrassment of getting rid of their patients to an unknown dentisttheir patients to an unknown dentist

You must be patient and You must be patient and understanding to this situation understanding to this situation

It may need the existing practice It may need the existing practice team to get the patient's initial team to get the patient's initial approval for the changeapproval for the change

Once the referral has taken place Once the referral has taken place the contest is within the hand of the the contest is within the hand of the new dentist, to prove himself.new dentist, to prove himself.

For a new comer younger dentist to For a new comer younger dentist to start an established practice busy start an established practice busy enough to relive him/her of the enough to relive him/her of the worry of acquiring a new patientworry of acquiring a new patient

The condition at which it may occur, The condition at which it may occur, is having a new patient.is having a new patient.

Old patients may protest and claim Old patients may protest and claim being rid of by the owner of the being rid of by the owner of the clinic to unknown dentistclinic to unknown dentist

His personality & relationship with His personality & relationship with patients must be pleasing, he must patients must be pleasing, he must show compassion, be gentleshow compassion, be gentle

He must not compete or degrade his He must not compete or degrade his bossboss

He must show the advantage of his He must show the advantage of his youthful appearance of the new& youthful appearance of the new& latest methods & techniques in latest methods & techniques in dentistrydentistry

The next problem is being short of The next problem is being short of patientspatients

Being pleasant, skilful, friendly, Being pleasant, skilful, friendly, compassionate, definitely will attract compassionate, definitely will attract more patients.more patients.

A common failing is the use of language A common failing is the use of language the patient does not understandthe patient does not understand

One has to explain each procedure to One has to explain each procedure to the patient language & general the patient language & general comprehensioncomprehension

The dentist who spend a little time The dentist who spend a little time discussing the procedures to be discussing the procedures to be advised and does this in simple advised and does this in simple everyday language will often find an everyday language will often find an appreciative and co-operative appreciative and co-operative patient. patient.

The influence of chargesThe influence of charges

A free system of payment in Sudan and A free system of payment in Sudan and other countries, although in others the other countries, although in others the fees of each procedure performed by GP fees of each procedure performed by GP or specialist is governed and established.or specialist is governed and established.

The first system allow any dentist The first system allow any dentist whatever his standards to make a living.whatever his standards to make a living.

Often the lower standards the better Often the lower standards the better income income

Because of the accelerated inflation, the Because of the accelerated inflation, the dentist is finding it necessary to compete dentist is finding it necessary to compete with care and service and has to give with care and service and has to give value he is giving to the patient for the value he is giving to the patient for the fees he is demanding.fees he is demanding.

The patient himself is comparing The patient himself is comparing between the service he is getting to the between the service he is getting to the fees he is paying.fees he is paying.

An advice from a senior colleague, An advice from a senior colleague, accountant receptionist is recommended, accountant receptionist is recommended, with due respect for socioeconomic with due respect for socioeconomic status for the patients of the areastatus for the patients of the area

Generally, older patient tend to refuse Generally, older patient tend to refuse paying much for procedure in paying much for procedure in comparison to younger ones.comparison to younger ones.

A patient who is regular visitor an A patient who is regular visitor an older dentist also will find the fees older dentist also will find the fees unexplainably high.unexplainably high.

A differential charges between A differential charges between dentists for the same practice gives dentists for the same practice gives the impression to patients there is a the impression to patients there is a lower charge because the dentist is lower charge because the dentist is somewhat inferior in his standards somewhat inferior in his standards

Other aspect that is the quality of Other aspect that is the quality of patients who present to the new patients who present to the new dentist with lower charges are those dentist with lower charges are those of problematic in nature, although it is of problematic in nature, although it is an opportunity to test your kindness, an opportunity to test your kindness, cold nerves, controlling pattern.cold nerves, controlling pattern.

There are two schools, one is There are two schools, one is discussing the fees with the patients discussing the fees with the patients the other does not the other does not

How the patient will pay ?How the patient will pay ? Pay in advancePay in advance Having an accountHaving an account

Young dentist should suspect who Young dentist should suspect who looks smart and honest because of looks smart and honest because of thier financial inability thier financial inability

Dentist must be clear, and definite Dentist must be clear, and definite about fees otherwise he will loose about fees otherwise he will loose honest who will pay even if under honest who will pay even if under protestprotest

Starting your Starting your own practiceown practice

Making oneself knownMaking oneself known

The dentist has find his own patientsThe dentist has find his own patients Where do they come fromWhere do they come from

Being pleasant, skilful, friendly, Being pleasant, skilful, friendly, compassionate, definitely will attract compassionate, definitely will attract more patients.more patients.

A common failing is the use of A common failing is the use of language the patient does not language the patient does not understandunderstand

One has to explain each procedure One has to explain each procedure to the patient language & general to the patient language & general comprehensioncomprehension

Patient sourcesPatient sources

FamilyFamily FriendsFriends Referral of emergenciesReferral of emergencies Referral by doctors & dentistsReferral by doctors & dentists Recommendations by those patients Recommendations by those patients

already seenalready seen

Appointment bookAppointment book

Filling the appointment bookFilling the appointment book Never saying there is nothing to do Never saying there is nothing to do

if I came waiting for patients to if I came waiting for patients to come come

Basic Furnishing Basic Furnishing & Equipment& Equipment

Buy only what is needed in the Buy only what is needed in the immediate foreseeable futureimmediate foreseeable future

If offered some new gadget a carful If offered some new gadget a carful appraisal should be made of its appraisal should be made of its properties, and reports and properties, and reports and evaluation by other dentists in evaluation by other dentists in practice conditionspractice conditions

Ergonomics Ergonomics

The study that concerns the relation The study that concerns the relation between workers and their energy and between workers and their energy and environmentenvironment

In dentistry, it is concerned with the In dentistry, it is concerned with the study of unnecessary movement and study of unnecessary movement and wasted energy, saving time, lessening wasted energy, saving time, lessening fatigue.fatigue.

Dentistry is physically demanding Dentistry is physically demanding profession, long hours is spent in one profession, long hours is spent in one position position

Standing for a long period of time will cause Standing for a long period of time will cause varicose, strain in musculoskeletal systemvaricose, strain in musculoskeletal system

Consideration should start with the Consideration should start with the positioning of the dental chair in relation to positioning of the dental chair in relation to the door & patient path.the door & patient path.

Another parameter is the entrance of light Another parameter is the entrance of light positionposition

Once the chair position is established, Once the chair position is established, plumbing for the wash basin is arranged, plumbing for the wash basin is arranged, near to the dentist.near to the dentist.

Base cabinet should have tops at Base cabinet should have tops at comfortable height for dentist to workcomfortable height for dentist to work

Designers Designers

A satisfactory practical workable A satisfactory practical workable apparently clean design is preferableapparently clean design is preferable

A conference between designer, plumber, A conference between designer, plumber, electrician and those wishing to supply electrician and those wishing to supply equipmentequipment

Those people should work under Those people should work under supervision of the dentist who guide supervision of the dentist who guide toward his objectivestoward his objectives

Never hesitate of asking any stupid Never hesitate of asking any stupid question!question!

Equipment Equipment

Specialist dentist will know what items Specialist dentist will know what items required, the followings are concerned required, the followings are concerned with the general practitioners.with the general practitioners.

Planning for the future can take place Planning for the future can take place when economic factor improves.when economic factor improves.

Some of the equipment is bought as a Some of the equipment is bought as a second hand so you need to take care second hand so you need to take care ( the poor can not afford the cheap.( the poor can not afford the cheap.

Dental chairsDental chairs

Most patients do not like Most patients do not like one arm chairone arm chair Flat head restFlat head rest Chairs with noisy mechanisms or Chairs with noisy mechanisms or

with type of stimulated leather that with type of stimulated leather that make noises as patients movemake noises as patients move

The more complicated, the more The more complicated, the more difficult to fix if it goes wrongdifficult to fix if it goes wrong

Recent chairs are computerized, but they Recent chairs are computerized, but they guaranteed from companies unless there guaranteed from companies unless there is misuse of dentist.is misuse of dentist.

They supplied with new accessories that They supplied with new accessories that you need (non touchable light, suction, you need (non touchable light, suction, high hand piece, air dispenser light cure high hand piece, air dispenser light cure applicator, ultrasonic scaler, intraoral applicator, ultrasonic scaler, intraoral camera, X-ray viewer etc…).camera, X-ray viewer etc…).

A programmed position is set even an A programmed position is set even an emergency position emergency position

Dental stool Dental stool

Requirement are:Requirement are: Comfort at all positionsComfort at all positions Support for the backSupport for the back Easily adjustable for heightEasily adjustable for height Should be stableShould be stable Should be movable when requiredShould be movable when required

The suction/ spittoonThe suction/ spittoon

Some clinics are supplied central Some clinics are supplied central suction, to place the motor in suction, to place the motor in distance from the clinic.distance from the clinic.

Most today's clinics the suction & Most today's clinics the suction & spittoon are built within the dental spittoon are built within the dental unit, the difference is the quality in unit, the difference is the quality in companies. companies.

Compressor Compressor

The compressor needs to be:The compressor needs to be: Powerful in performing the desired Powerful in performing the desired

pressure with either low speed or pressure with either low speed or high speed hand pieces.high speed hand pieces.

Quite & friendly with much noisesQuite & friendly with much noises Time of regular check ups is Time of regular check ups is

important for the air and oilimportant for the air and oil

Autoclave Autoclave

An essential item in the dental clinic, An essential item in the dental clinic, may assure the quality of standards may assure the quality of standards the dentist aiming at.the dentist aiming at.

If expensive its cost is wastedIf expensive its cost is wasted It should be big enough to It should be big enough to

accommodate clinic's items.accommodate clinic's items. In the contract at least 2 years In the contract at least 2 years

maintenance is advised. maintenance is advised.

Other items Other items

Sphygmomanometer, stethoscopeSphygmomanometer, stethoscope Amalgam mixerAmalgam mixer Digital timerDigital timer Pulp testerPulp tester Root canal depth indicatorRoot canal depth indicator Panoramic X-rayPanoramic X-ray Oxygen unitOxygen unit General anaesthesia equipmentGeneral anaesthesia equipment

Laboratory equipmentLaboratory equipment

Although the dentist is sending Although the dentist is sending dentures and bridges to a dentures and bridges to a commercial lab, sometimes some commercial lab, sometimes some preliminary technician job & preliminary technician job & corrections needed to be made at corrections needed to be made at the clinicthe clinic

Water distillationWater distillation

Dirty water may damage the water Dirty water may damage the water circuit in the dental unit, filter or circuit in the dental unit, filter or water distiller is important at the water distiller is important at the context context

Installation & servicesInstallation & services

Air, water, electricity and drainage Air, water, electricity and drainage will be requiredwill be required

The installation of waste pipes is the The installation of waste pipes is the most difficult task of all.most difficult task of all.

Plumbing is vital in cross infection Plumbing is vital in cross infection issuesissues

Clinical Clinical photographyphotography

Why the camera ?Why the camera ?

Before and after photographs to Before and after photographs to demonstrate improvement in oral demonstrate improvement in oral conditioncondition

To demonstrate the merit of To demonstrate the merit of different materialsdifferent materials

Recording of unusual & interesting Recording of unusual & interesting oral conditionsoral conditions

The provision of teaching materialThe provision of teaching material

The waiting roomThe waiting room

It is better to call it the reception roomIt is better to call it the reception room You need to implement your own personality You need to implement your own personality

in it in it You do not need to give education because You do not need to give education because

they are quite anxious .they are quite anxious . The waiting time should be brief The waiting time should be brief Receptionist should welcome the patient and Receptionist should welcome the patient and

make it clear that we know his arrivalmake it clear that we know his arrival The question of music or other entertaining The question of music or other entertaining

material is becoming mandatorymaterial is becoming mandatory Furniture of the waiting room to be cleansableFurniture of the waiting room to be cleansable The bathroom must be kept clean all the time.The bathroom must be kept clean all the time.

The business The business office office

Computer Computer

It is advisable to acquire computer It is advisable to acquire computer in the clinic to save, organize datain the clinic to save, organize data

New software for dental practice New software for dental practice management is designed for clinics management is designed for clinics according to their needs.according to their needs.

This software is easily trained for This software is easily trained for the receptionist the receptionist

Copying machine Copying machine

It is used in our practice for:It is used in our practice for: Daily appointment schedule, one Daily appointment schedule, one

copy to each dentistcopy to each dentist Information to be given to patients Information to be given to patients

eg. instructionseg. instructions

TelephoneTelephone & &

answering machine answering machine

It is useful aid in good patient It is useful aid in good patient relationshiprelationship

It is used to make patient able to It is used to make patient able to cancel or to change his appointmentcancel or to change his appointment

Their message should be short Their message should be short

Dictating machine Dictating machine

Micro cassette to help the dentist Micro cassette to help the dentist leaving a message, written material leaving a message, written material for copying, medical report etc…for copying, medical report etc…

The appointment The appointment bookbook

Appointment book is a planning Appointment book is a planning system for dentist and for the other system for dentist and for the other operating staff members and should operating staff members and should be a method of planning free time as be a method of planning free time as well as chairside time.well as chairside time.

It should be stressed that the only It should be stressed that the only earning power is in the time given to earning power is in the time given to patientspatients

A general plan of A general plan of appointment makingappointment making

Extractions are better done earlier in Extractions are better done earlier in the day so that by the end of the day the day so that by the end of the day freedom from excessive discomfort or freedom from excessive discomfort or haemorrhage can be assured. haemorrhage can be assured.

It is often recommended that children It is often recommended that children be seen early in the day, obviously not be seen early in the day, obviously not school time!school time!

It is good idea to leave new patients It is good idea to leave new patients requiring examination, consultation, requiring examination, consultation, X-rays, etc.. , to the end of the dayX-rays, etc.. , to the end of the day

Emergencies should ideally be seen Emergencies should ideally be seen in two selected periods during the in two selected periods during the day, the 1st half hour is left openday, the 1st half hour is left open

Ensure open communication with Ensure open communication with patient during the daytime hours of patient during the daytime hours of openingopening

A short notice list of A short notice list of patientspatients

Is a list of patients that can be used to fill Is a list of patients that can be used to fill in late cancellations or blanks in the in late cancellations or blanks in the day .day .

This is a list of patients a secretary This is a list of patients a secretary should keep at reach & consist of should keep at reach & consist of patients who live or work nearby and patients who live or work nearby and come at short notice for treatmentcome at short notice for treatment

Could be classified into 1 hour, 3 hours, Could be classified into 1 hour, 3 hours, 24 hours according to the time required 24 hours according to the time required to attend. to attend.

General considerations in General considerations in caring for the new patientscaring for the new patients

First impressionFirst impression The approachThe approach Introduce yourself to the patientIntroduce yourself to the patient Shake handsShake hands Careful general & dental history is Careful general & dental history is

takentaken Attentive listening with interest is Attentive listening with interest is

important.important. Match question & instruction with the Match question & instruction with the

pace of & comprehension of the patient pace of & comprehension of the patient

Staff Staff

The dental team may be consist of: The dental team may be consist of: the senior dentist, a partner (if any), the senior dentist, a partner (if any), dentist assistant, dental hygienist, dentist assistant, dental hygienist, secretary/receptionist, dental secretary/receptionist, dental chairside assistant, dental chairside assistant, dental technician, (and often) the patient.technician, (and often) the patient.

A four to six weeks period of testing A four to six weeks period of testing a staff is satisfactorya staff is satisfactory

Redundancy & firingRedundancy & firing

A staff who have been employed A staff who have been employed continuously for more than 2 years can continuously for more than 2 years can not be fired without a very good reasonnot be fired without a very good reason

Tell employee formally that their Tell employee formally that their conduct is unsatisfactory, giving a conduct is unsatisfactory, giving a timetable for improvement, advice, and timetable for improvement, advice, and help.help.

Give written warning that if there is no Give written warning that if there is no improvement, dismissal will follow.improvement, dismissal will follow.

Give written notice as per contract.Give written notice as per contract.

Redundancy paymentRedundancy payment

These are made for members who have These are made for members who have been employed for the minimum legal been employed for the minimum legal periodperiod

Payment do not have to be made to Payment do not have to be made to employee:employee:

1.1. Who work less than 2 years (104 weeks)Who work less than 2 years (104 weeks)

2.2. Who workless than 21 hour per weekWho workless than 21 hour per week

3.3. Who are or will be over 65 yrs at the the Who are or will be over 65 yrs at the the termination of the service.termination of the service.

Of continuous serviceOf continuous service

Health care in Health care in the practicethe practice

Hazards to the dental Hazards to the dental teamteam

MercuryMercury Posture problemPosture problem ElectricalElectrical Injuries from instrumentsInjuries from instruments X-raysX-rays Infection- hepatitis BInfection- hepatitis B Anaesthetic gasesAnaesthetic gases Allergies- skin reaction Allergies- skin reaction Inhalation of aerosols Inhalation of aerosols

Continuing Continuing educationeducation

Keeping with contemporary Keeping with contemporary dentistrydentistry

Regular reading of dental journalsRegular reading of dental journals Joining a learned societyJoining a learned society Enrolling in coursesEnrolling in courses Attending dental meetingsAttending dental meetings Part-time teaching at dental schoolPart-time teaching at dental school The pankey continuumThe pankey continuum Internet or www. Internet or www.

Evidence-based DentistryEvidence-based Dentistry The concept of using current evidence to guide The concept of using current evidence to guide

decision-making was first introduced by Gordon decision-making was first introduced by Gordon Guyatt and the Evidence-Based Medicine Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Working Group at McMaster University in Ontario, Canada in the 1990s. A new concept for Ontario, Canada in the 1990s. A new concept for medical education designed to incorporate medical education designed to incorporate current research into education and practice current research into education and practice was developed to help practitioners provide the was developed to help practitioners provide the best care for their patients.best care for their patients.

The term evidence-based medicine (EBM)is The term evidence-based medicine (EBM)is defined as "the integration of best research defined as "the integration of best research evidence with clinical expertise and patient evidence with clinical expertise and patient values." values."

The new concept of EBM utilizes a The new concept of EBM utilizes a systematic process to incorporate systematic process to incorporate current research into practice. current research into practice.

The evidence-based process The evidence-based process requires the development of requires the development of

five key skills:five key skills:1.1. Formulate information needs/questions into Formulate information needs/questions into

four part questions. These questions identify four part questions. These questions identify the patient/problem (P), intervention (I), the patient/problem (P), intervention (I), comparison (C), and outcomes (O) also known comparison (C), and outcomes (O) also known as PICO questions. as PICO questions.

2.2. Conduct an efficient computerized search of Conduct an efficient computerized search of the literature for the appropriate type and the literature for the appropriate type and level of evidence. level of evidence.

3.3. Critically appraise the evidence for validity Critically appraise the evidence for validity with an understanding of research methods. with an understanding of research methods.

4.4. Apply the results of the evidence to patient Apply the results of the evidence to patient care or practice in consideration for the care or practice in consideration for the patient's preferences, values and patient's preferences, values and circumstances. circumstances.

5.5. Evaluate the process and your performance Evaluate the process and your performance through self-evaluation.through self-evaluation.

Levels of evidenceLevels of evidence

When deciding whether to When deciding whether to implement evidence from a study, it implement evidence from a study, it is important to look at the type of is important to look at the type of study design employed, which study design employed, which determines the “strength” of determines the “strength” of evidence on which to base the evidence on which to base the clinical decision.clinical decision.

The 5 levels of evidenceThe 5 levels of evidence

1a. Systematic review of multiple randomized 1a. Systematic review of multiple randomized controlled trials (RCTs)controlled trials (RCTs)

1b. Individual well-designed RCT1b. Individual well-designed RCT2a. Systematic review of cohort studies2a. Systematic review of cohort studies2b. Individual cohort study, or low quality RCT2b. Individual cohort study, or low quality RCT3a. Systematic review of case control studies3a. Systematic review of case control studies3b. Individual case control study3b. Individual case control study4. Non-analytical studies (case series)4. Non-analytical studies (case series)5. Opinions of expert committees or respected 5. Opinions of expert committees or respected

authoritiesauthorities

A A randomized controlled randomized controlled trial (RCT)trial (RCT)

is a type of scientific is a type of scientific experimentexperiment most most commonly used in testing the commonly used in testing the efficacyefficacy or or effectivenesseffectiveness of healthcare services or clinical of healthcare services or clinical research . The key distinguishing feature of the research . The key distinguishing feature of the usual RCT is that study subjects, after usual RCT is that study subjects, after assessment of eligibility and recruitment, but assessment of eligibility and recruitment, but before the intervention to be studied begins, before the intervention to be studied begins, are randomly allocated to receive one or other are randomly allocated to receive one or other of the alternative treatments under study. of the alternative treatments under study. Random allocation in real trials is complex, but Random allocation in real trials is complex, but conceptually, the process is like tossing a coin. conceptually, the process is like tossing a coin. After randomization, the two (or more) groups After randomization, the two (or more) groups of subjects are followed up in exactly the same of subjects are followed up in exactly the same way, and the only differences between the care way, and the only differences between the care they receive they receive

A A systematic reviewsystematic review

Is a literature review focused on a Is a literature review focused on a single question that tries to identify, single question that tries to identify, appraise, select and synthesize all appraise, select and synthesize all high quality research evidence high quality research evidence relevant to that question. Systematic relevant to that question. Systematic reviews of high-quality randomized reviews of high-quality randomized controlled trials are crucial to controlled trials are crucial to evidence-based medicine.evidence-based medicine.

A A cohort studycohort study is a form of longitudinal study (a is a form of longitudinal study (a type of observational study) used in medicine, type of observational study) used in medicine, dentistry. It is an analysis of risk factors and dentistry. It is an analysis of risk factors and follows a group of people who do not have the follows a group of people who do not have the disease, and uses correlations to determine the disease, and uses correlations to determine the absolute risk of subject contraction. It is one type absolute risk of subject contraction. It is one type of clinical study design and should be compared of clinical study design and should be compared with a cross-sectional study. with a cross-sectional study.

A cohort is a group of people who share a A cohort is a group of people who share a common characteristic or experience within a common characteristic or experience within a defined period (e.g., are born, are exposed to a defined period (e.g., are born, are exposed to a drug or a vaccine, etc.). drug or a vaccine, etc.).

Case-control studyCase-control study

is a type of retrospective, epidemiological, is a type of retrospective, epidemiological, clinical study design. In a case-control clinical study design. In a case-control study, people with a disease (often, a study, people with a disease (often, a specific diagnosis, perhaps lung cancer) are specific diagnosis, perhaps lung cancer) are matched with people who do not have the matched with people who do not have the disease (the 'controls').disease (the 'controls').

Further data are then collected on those Further data are then collected on those individuals and the groups are compared to individuals and the groups are compared to find out if other characteristics (perhaps a find out if other characteristics (perhaps a history of smoking) are also different history of smoking) are also different between the two groups. between the two groups.

A A case seriescase series

(also known as a (also known as a clinical seriesclinical series) is ) is a medical research observational a medical research observational study that tracks patients with a study that tracks patients with a known exposure given similar known exposure given similar treatment or examines their medical treatment or examines their medical records for exposure and outcome. records for exposure and outcome.

It can be retrospective or It can be retrospective or prospective .prospective .