Evidence-Based Medicine Introductory Session - Revised Sept 07

8/2/2019 Evidence-Based Medicine Introductory Session - Revised Sept 07

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Evidence-Based Medicine

Introduction


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Course Web Sitehttp://courses.washington.edu/ebmed/EBM/index.shtml

You can link to this site from the Medicine Residency webpage, the Roosevelt GIMC Residents web page, or HSL

Evidence Based Practice web page.


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Evidence-based medicine isthe integration of the best

available research evidencewith clinical expertise and

patient values.


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Why Teach and Practice EBM?

It is required to be taught by ABIM. Outcomes research has documented that

patients who do receive evidence-basedtherapies have better outcomes than thosewho dont.

It may be a more efficient means of remainingcurrent than traditional methods (e.g. journal

subscriptions). A host of developments make EBM more

possible than ever.


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Developments

Efficient strategies for tracking andappraising evidence.

Availability of evidence-based journals.

Creation of systematic reviews andconcise summaries.

Information systems allowing access to

resources in seconds.


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Objectives

Hands-on, real-time learning of skillsnecessary to incorporate EBM into your dailypractice of medicine.

Provide the opportunity to apply these skills toactual clinical encounters.

Have fun learning and teaching others.

Minimize work outside of day to day clinicalresponsibilities.


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Responsibilities

Attend all the sessions.

Each week during your clinicalencounters generate at least one

question about patient care you wouldlike to try and answer in EBM. We willtackle these questions thematically(therapy, prognosis, diagnosis).

Apply and teach what you learn.


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Steps in Practicing EBM

1. Convert the need for information into ananswerable question.

2. Track down the best evidence with which to

answer that question.3. Critically appraise the evidence for its

validity, impact, and applicability.

4. Integrate the evidence with our clinical

expertise and our patients characteristics

and values.


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Limitations*

Time. Shortage of coherent and consistent

scientific evidence (therapeutic nihilism).

Challenges of applying evidence to careof individual patients.

General barriers to the practice ofquality medicine (e.g. costs, patientexpectations, etc.).


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Putting Skills into Practice

Find evidence supporting one clinicaldecision 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-basedanswers.


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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 practicesession

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 practicesession

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 ofTherapy ?s

Think ofPrognosis

?s

Think ofDiagnosis

?s

Think ofHarm ?s


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The Answerable Question


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expertise and our patients characteristicsand values.


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Good questions are thebackbone of practicing EBM.

It takes practice to ask thewell-formulated question.


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The nature of the question

asked is critically experiencedependent.

GENERAL KNOWLEDGE

SPECIFIC KNOWLEDGE

TYPE OF

QUESTION

CLINICAL EXPERIENCE


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Differences in Type of ?s

Background questioncomposed of questionmodifier and condition.

Cover the full range ofbiologic, psychologic, orsociologic aspect of humanillness

Can be answered byreference works.*

Can be used as a trampolinefor generating specificquestions to be answered byEBM.

Foreground questioncomposed of patient and/orproblem, intervention(therapy, diagnostic test,etc.), comparison andoutcome.

Often requires morecomprehensive andintensive search strategies

(not necessarily more timeconsuming).

Suitable to answering usingthe techniques of EBM.

General Specific


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Well-Built Clinical ?s

Directly relevant to the care of the patient andour knowledge deficit.

Contains the following elements:

the patient or problem being addressed the intervention or exposure being considered

the comparison intervention or exposure, whenrelevant

the clinical outcomes of interest.


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Well Formulated ?s

Focus scarce learning time on evidence directlyrelevant to patients 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 ourcolleagues and students.

Are answerable and, thus, reinforce the satisfactionof finding evidence that makes us better, fasterclinicians.


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Q: How do you find currentbest evidence?

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


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Q: What is best evidence?

OR

Q: What kind of evidence is least likely to bewrong?


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The Evidence Pyramid

Validity/Strengtho

fInference

TimeSpent

inCriticalAp

praisal


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Levels of Evidence


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ResourcesMETA-SEARCH ENGINES

PrimeAnswersTRIP+SUMSearch

SYSTEMATIC REVIEWS/META-ANALYSES

Cochrane LibraryPubMed Clinical Queries using Research Methodology Filters

EVIDENCE GUIDELINES/SUMMARIES

AHRQ Evidence ReportsClinical EvidenceAHRQ Preventive Services

CLINICAL RESEARCH CRITIQUES

ACP Journal Club 1996-

Bandolier 1994-BestBETs

CASE REPORTS/SERIES, PRACTICE GUIDELINES, ETC

National Guideline ClearinghousePubMed


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Documents

Evidence-Based Medicine Introductory Session - Revised Sept 07