Evidence for health care decisions: Overcoming the ... fileLearning and teaching ebm_2011_03_26 3 Readers of the BMJ recently ranked Evidence-Based Medicine as one of the ten most

Evidence for health care decisions:

Overcoming the challenges

Learning and teaching evidence-based health care

Regina Kunz

asim

University Hospital Basel

2Learning and teaching ebm_2011_03_26

Content

Evidence-based medicine

Early days: David Sackett, McMaster University

Successors: Gordon Guyatt, Paul Glasziou, Victor Montori

Principles of teaching and learning

Science of teaching and learning

- Evaluate teaching

- Predictors

- Postgraduate teaching: any changes?

- Teaching and learning on-site


Readers of the BMJ recently ranked Evidence-Based

Medicine as one of the ten most important medical

breakthroughs of the 20th century

Medical Milestones 2001. BMJ.

2010


Teaching ebm: The principles

Starting with a patient or a problem

- Formulating answerable clinical questions

- Searching for the best evidence

- Critical appraisal of the evidence

- Applying evidence to patients

- Self-evaluation



Teaching Tips: A Culture of Teaching ….

Good questions: backbone of practicing and teaching EBM

Questions that are patient-based and learner centred

Teach by example: Model question formulation for your learners

Describe the process of building a question: What are the elements of a well-built clinical question?

Recognise potential questions in the learner's cases and help the learner focus on the question(s) they want answered most.

Target opportunities: Postcall rounds with a group of exhausted housestaff may not be the ideal time. Identify opportunities like while you're waiting for the elevator or for all the team members to show up.

Give feedback: Give the learner some constructive feedback on their

question formulation.


The EBM toolbox



Vice President Al Gore Launches PubMed, Lauds Free MEDLINE Access

15-Jul-1997

MEDLINE...will henceforth be

available free to the

American people."

"This evelopment...may do

more to reform and improve

the quality of health care in

the United States than

anything else we’ve done in

a long time."

Searching for the best evidence


Searching for the evidence

What has changed in PubMed?

Free access to PubMed

Clinical queries

Cochrane library …

http://www.acpjc.org/

http://ebm.bmj.com/

http://ebmh.bmj.com/

http://ebn.bmj.com/

Journal of Evidence-Based Health Care

- http://www.wiley.com/bw/journal.asp?re

f=1744-1595

Cochrane Library

http://thecochranelibrary.com/

UpToDate

http://www.uptodateinc.com/

Clinical queries hervorheben

http://www.acpjc.org/

http://ebm.bmj.com/

http://ebmh.bmj.com/

http://ebn.bmj.com/

http://www.wiley.com/bw/journal.asp?ref=1744-1595




http://thecochranelibrary.com/

http://www.uptodateinc.com/


The Science of Teaching & Learning


Instruments to

Measure Change

Shaneyfelt, T. et al. JAMA 2006;296:1116-1127

●

●

●

●

●

●

●

●

● ●


Predictors for successful teaching


●

●

●

Learner Characteristics:

clinicians & medical publishing; Self-perceived advanced knowledge

●


Does teaching ebm result in

clinically important changes ?

Changes in knowledge, skills,

attitude, and behaviour after

critical appraisal skills or EBM

teaching, grouped by quality of

studies.

“What is the evidence that postgraduate teaching in evidence based

medicine changes anything? A systematic review.”

A. Coomarasamy, K. S. Khan; BMJ 2004


Teaching and learning on-site

ebm unity project (I): the learners

„ A European Curriculum in EbM ….. to equip

today’s physicians with the skills and

knowledge they need to search efficiently for current best evidence to

make informed decisions about patient care”

Blended learning - at the workplace: e-learning and on-site learning

● Integrates the concepts of problem-based learning and life-long learning

● Integrated teaching improves not only knowledge, but also skills and

attitudes

United Kingdom; Germany; Austria; Italy; Poland; The Netherlands; Spain; Hungary; Switzerland


Overview of teaching & learning activities in the

EU EBM course

Successfully devised a clinically integrated EBM e-learning course for students of EBM

Five modules with clinical and e-learning components and assessments

Performs as well as face to face teaching

Coppus SF, Emparanza JI, Hadley J, Kulier R, Weinbrenner S, Arvanitis TN et al. A clinically integrated

curriculum in evidence-based medicine for just-in-time learning through on-the-job training: the EU-EBM

project. BMC Med Educ 2007; 7:46.


Summary

Tipps and Tools

Video clip

Case scenario

Ebm steps covered

in session

Learning objectives

Structure of module Teaching and learning

on-site:

ebm unity project (I):

the teachers



International Society of Evidence-based Health Care:

Mission and Vision

Mission

… to develop and encourage research in evidence-based health care

… to promote and provide professional and public education

Vision

… a world-wide platform for interaction and collaboration among

practitioners, teachers, researchers and the public to promote EBHC

… to provide support to frontline clinicians making day-to-day decisions,

and to those who have to develop curricula and teach EBHC

THE FOUNDING BOARD MEMBERS are: India: Kameshwar Prasad Australia: P.Glasziou; Canada: G.H.Guyatt;

Canada: D. Davis; P.Tugwell; Germany: H.Bastian; Italy: N.Cartabellotta; Phillipines: T.Dans; Saudi Arabia: L.A. Al-Ansary; M. El Barbary;

Spain: J.Emparanza; Switzerland: R.Kunz; Taiwan: K.Kuo; UK: C.Heneghan ; United Arab Emirates: H.Hamdy


e-modules

E-learning sessions designed to allow learning in the workplace during short breaks

Option to interrupt and restart learning flexibly

Self-directed, independent e-learning

Slides and written scripts; a talking head; video

5 languages (English, French, German, Hungarian, Polish)

Access by website, Video Podcasts, CD ROM, Face book




Documents

Evidence for health care decisions: Overcoming the ... fileLearning and teaching ebm_2011_03_26 3 Readers of the BMJ recently ranked Evidence-Based Medicine as one of the ten most