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Teaching Evidence-Based Medicine Across the Curriculum

Teaching Evidence-Based Medicine Across the Curriculum. Gundy Sweet, PharmD , FASHP Clinical Associate Professor University of Michigan, College of Pharmacy. Objectives.

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Teaching Evidence-Based Medicine Across the Curriculum

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  1. Teaching Evidence-Based Medicine Across the Curriculum Gundy Sweet, PharmD, FASHP Clinical Associate Professor University of Michigan, College of Pharmacy

  2. Objectives • Provide a brief overview of the UofM College of Pharmacy curriculum specific to the development of evidence-based medicine skills and concepts • Briefly discuss how the curriculum revision process will strive to further develop these skills

  3. What is EBM? • Combine the best evidence from clinically relevant studies • Add in your clinical expertise to determine if it applies to the individual patient • And incorporate the patient’s values All done to make the best decision for a given situation Sackett D, 1996

  4. Common Student (mis)Perception • You don’t need to teach me this stuff…. • I already know how to look for things…. • I’m a Gen-Nexter • But few students have a systematic process to identify the best evidence specific to a given situation • Why is that important?

  5. 2006: 20,824 journals (medical sciences) • 2009: > 679,000 citations added to Medline Too many sources of information

  6. Information explosion 2X • Research information doubles every 10 years • Explosion of mis-information

  7. Traditional resources often inadequate • Textbooks can be outdated • Many books take 1-3 years to get to print

  8. Readily available search tools • 1986: Medline available via librarians • Today: numerous search tools readily available

  9. More knowledgeable patient • 30% of adults seeing MD discuss a drug they saw through DTC advertising • almost ½ of these patients received a RX for the drug

  10. Daily need for valid information

  11. 10% of drugs on market between 1975-1999 pulled from market/black box warning added • 1/2 of all withdrawals within 2 years Increase in number, sophistication, and safety concerns with drugs/medical interventions

  12. Feeling Overwhelmed??? Traditional resources often inadequate Readily available search tools Information explosion More knowledgeable patient Too many sources of information Increase in number and sophistication of drugs/medical interventions Daily need for valid information

  13. How and where are the skills taught? • EBM Course • EBM concepts • How to formulate a clinical question • Importance of clarity of the question • Helps direct you to the most appropriate resources • Helps ensure communication of a clear response • How to apply the systematic approach to handling requests for information

  14. What is the Systematic Approach • The systematic approach is an integral part of the EBM strategy • Helps search for the most relevant literature to enhance efficiency and effectiveness • The systematic approach is comprised of 7 steps: • BUT… conducting a systematic search requires knowledge of the advantages/disadvantages associated with each type of information resource 1. Classify  2.Clarifying information  3. Systematic Search (3o2o1o)  4. Evaluate  5. Apply  6. Communicate  7. Follow-up

  15. Where Students Learn About Resources • EBM Course • Textbooks and general drug information resources • Searching the biomedical literature • What to use when • PubMed, Embase, Google, IPA, Cochrane, others • Using the internet - is it reliable? • Author credentials • Currency of the information • Source of funding • Awareness of extensions (.biz .com .edu.gov) • External validation of content

  16. What about the primary literature? • EBM Course • How to find the primary literature • Efficient and effective searching • How to read and interpret the primary literature • Terminology (R, DB, PC, DD, etc) • Different types of trials (systematic reviews, economic analyses, randomized controlled trials, case reports) • Levels of evidence • Appropriate statistical tests • Assess all elements of the study, practicing on different published clinical trials

  17. Using EBM Skills • EBM Course and beyond • How do I apply the information? • Does the information found apply to the clinical situation (indication, age group, etc)? • Are the results clinically important (and not just statistically significant)? • Is the information found sufficient to answer the question? • How should I communicate the information? • Are there any ethical considerations to take into account?

  18. Application of EBM Principles • P1 Year • EBM Course (W) • Therapeutics • Reinforce identification of best evidence • Integrate critical appraisal to clinical situations • Research Principles • Practical, application-based course where students write a ‘practice’ research proposal • Requires they understand and apply EBM principles • Study terminology • Study design • Searching primary literature • Learn to logically think through a problem and define a plan • P2 Year • Therapeutics (F/W) • Research Principles (W)

  19. Application of EBM Principles • Therapeutics • Reinforce identification of best evidence/integrate critical appraisal • Pcare (IPPE) • Discuss patient cases that requires use of best evidence • Reinforce primary literature review (journal clubs) • PharmD Research Project • Application of research principles • Emphasis on process of conducting research • P1 Year • EBM Course (W) • P3 Year • Therapeutics (F/W) • Pcare (IPPE) • PharmD Research (W) • P2 Year • Therapeutics (F/W) • Research Principles (W)

  20. Application of EBM Principles • Clinical Rotations • Manage patients on rotations • Reinforce primary literature review • Drug Information is a required rotation • Conduct systematic review of topic • Critically evaluate literature on a topic • Retrieve/analyze/apply DI in practice • PharmD Research Project • Application of research principles • PharmD Seminar • Formal presentation • PharmD research or topic review • Requires application of all EBM skills • Search/analyze/apply information to a given situation • P1 Year • EBM Course (W) • P2 Year • Therapeutics (F/W) • Research Principles (W) • P4 Year • Clinical Rotations • PharmD Research • PharmD Seminar

  21. Application of EBM Principles • P1 Year • EBM Course (W) • P3 Year • Pcare (IPPE) • Therapeutics (F/W) • PharmD Research (W) • P2 Year • Therapeutics (F/W) • Research Principles (W) • P4 Year • Clinical Rotations • PharmD Research • PharmD Seminar

  22. EBM in New Curriculum • P1 Year • Introduce DI skills, resources, terminology • Begin to build a toolbox Curriculum revision is an ongoing, dynamic process • P3 Year • EBM/ethics course • Pcare (IPPE) • Therapeutics (F/W) • PharmD Research (W) • P2 Year • EBM: focus on literature evaluation and searching (F) • Research Principles (W) • Therapeutics (F/W) • P4 Year • Clinical Rotations • PharmD Research • PharmD Seminar

  23. Goals with the New Curriculum • Maximize active learning • Students more involved in learning by DOING • Increase opportunities in all courses for students to …. • not just KNOW the information but …. • to have the ability to APPLY information in practice

  24. In your packet is a document for your toolbox… A Guide to INFORMATION RESOURCES University of Michigan, College of Pharmacy TAUBMAN LIBRARY RESOURCES RESOURCES BASED ON TYPE OF QUESTION

  25. Questions

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