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Evidence-Based Medicine Introduction. Department of Medicine - Residency Training Program Tuesdays, 9:30 a.m. - 12:00 p.m. - UW Health Sciences Library. Faculty. Director: Matt Hollon MD MPH, Assistant Professor, UWMC General Internal Medicine, e-mail: mfhollon@u.washington.edu Instructors:

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evidence based medicine introduction

Evidence-Based MedicineIntroduction

Department of Medicine - Residency Training Program

Tuesdays, 9:30 a.m. - 12:00 p.m. - UW Health Sciences Library

faculty
Faculty

Director:

Matt Hollon MD MPH, Assistant Professor, UWMC General Internal Medicine, e-mail: mfhollon@u.washington.edu

Instructors:

Erin Fouch MD, Outpatient Chief Resident, July-December, e-mail: emsfouch@u.washington.edu

Travis Baggett MD, Outpatient Chief Resident, January-June, e-mail: baggettt@u.washington.edu

Librarians:

Sherry Dodson MLS, Clinical Medical Librarian, UW Health Sciences Library, e-mail: sdodson@u.washington.edu

course web site http courses washington edu ebmed ebm index shtml
Course Web Sitehttp://courses.washington.edu/ebmed/EBM/index.shtml

You can link to this site from the Medicine Residency web page, the Roosevelt GIMC Residents’ web page, or HSL Evidence Based Practice web page.

slide4
Evidence-based medicine is the integration of the best available research evidence with clinical expertise and patient values.
why teach and practice ebm
Why Teach and Practice EBM?
  • It is required to be taught by ABIM.
  • 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.
developments
Developments
  • Efficient strategies for tracking and appraising evidence.
  • Availability of evidence-based journals.
  • Creation of systematic reviews and concise summaries.
  • Information systems allowing access to resources in seconds.
objectives
Objectives
  • Hands-on, real-time learning of skills necessary to incorporate EBM into your daily practice of medicine.
  • Provide the opportunity to apply these skills to actual clinical encounters.
  • Have fun learning and teaching others.
  • Minimize work outside of day to day clinical responsibilities.
responsibilities
Responsibilities
  • Attend all the sessions.
  • Each week during your clinical encounters generate at least one question about patient care you would like to try and answer in EBM. We will tackle these questions thematically (therapy, prognosis, diagnosis).
  • Apply and teach what you learn.
steps in practicing ebm
Steps in Practicing EBM
  • Convert the need for information into an answerable question.
  • Track down the best evidence with which to answer that question.
  • Critically appraise the evidence for its validity, impact, and applicability.
  • Integrate the evidence with our clinical expertise and our patient’s characteristics and values.
limitations
Limitations*
  • Time.
  • Shortage of coherent and consistent scientific evidence (therapeutic nihilism).
  • Challenges of applying evidence to care of individual patients.
  • General barriers to the practice of quality medicine (e.g. costs, patient expectations, etc.).
putting skills into practice
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.
course structure 8 week cycle
Course Structure - 8 week cycle
  • Week 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 4
  • Critically appraise prognosis 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 6
  • Critically appraise diagnosis 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 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

steps in practicing ebm1
Steps in Practicing EBM
  • Convert the need for information into an answerable question.
  • Track down the best evidence with which to answer that question.
  • Critically appraise the evidence for its validity, impact, and applicability.
  • Integrate the evidence with our clinical expertise and our patient’s characteristics and values.
slide15
Good questions are the backbone of practicing EBM. It takes practice to ask the well-formulated question.
the nature of the question asked is critically experience dependent

SPECIFIC KNOWLEDGE

TYPE OF QUESTION

GENERAL KNOWLEDGE

CLINICAL EXPERIENCE

The nature of the question asked is critically experience dependent.
differences in type of s
“Background” question composed of question modifier and condition.

Cover the full range of biologic, psychologic, or sociologic aspect of human illness

Can be answered by reference works.*

Can be used as a trampoline for generating specific questions to be answered by EBM.

“Foreground” question composed of patient and/or problem, intervention (therapy, diagnostic test, etc.), comparison and outcome.

Often requires more comprehensive and intensive search strategies (not necessarily more time consuming).

Suitable to answering using the techniques of EBM.

Differences in Type of ?’s

General

Specific

well built clinical s
Well-Built Clinical ?’s
  • Directly relevant to the care of the patient and our knowledge deficit.
  • Contains the following elements:
    • the patient or problem being addressed
    • the intervention or exposure being considered
    • the comparison intervention or exposure, when relevant
    • the clinical outcomes of interest.
well formulated s
Well Formulated ?’s
  • Focus scarce learning time on evidence directly relevant to patient’s needs and our particular knowledge needs.
  • Suggest high-yield search strategies.
  • Suggest forms that useful answers might take.
  • Help us to model life-long learning techniques for our colleagues and students.
  • Are answerable and, thus, reinforce the satisfaction of finding evidence that makes us better, faster clinicians.
q how do you find current best evidence
Q: How do you find current best evidence?

A: Ask your librarian!Sherry Dodson - Clinical Medical Librarian

q what is best evidence
Q: What is best evidence?

OR

Q: What kind of evidence is least likely to be wrong?

steps in practicing ebm2
Steps in Practicing EBM
  • Convert the need for information into an answerable question.
  • Track down the best evidence with which to answer that question.
  • Critically appraise the evidence for its validity, impact, and applicability.
  • Integrate the evidence with our clinical expertise and our patient’s characteristics and values.
the evidence pyramid
The Evidence Pyramid

Time Spent in Critical Appraisal

Validity/Strength of Inference

resources
Resources

META-SEARCH ENGINES

PrimeAnswers

TRIP+

SUMSearch

SYSTEMATIC REVIEWS/META-ANALYSES

Cochrane Library

PubMed Clinical Queries using Research Methodology Filters

EVIDENCE GUIDELINES/SUMMARIES

AHRQ Evidence Reports

Clinical Evidence

AHRQ Preventive Services

CLINICAL RESEARCH CRITIQUES

ACP Journal Club 1996-

Bandolier 1994-

BestBETs

CASE REPORTS/SERIES, PRACTICE GUIDELINES, ETC

National Guideline Clearinghouse

PubMed

steps in practicing ebm3
Steps in Practicing EBM
  • Convert the need for information into an answerable question.
  • Track down the best evidence with which to answer that question.
  • Critically appraise the evidence for its validity, impact, and applicability.
  • Integrate the evidence with our clinical expertise and our patient’s characteristics and values.