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TEACHING EVIDENCE BASED PRACTICE
Random thoughts in a nutshell
Robert J. Weyant, DMD, DrPH
Chair, Department of Dental Public Health
University of Pittsburgh School of Dental Medicine
Who we teach
• Dental students
• Dental faculty
• Practicing dentists
What do we teach
• Just in time (not just in case) individual patient
treatment decisions.
• Some use of guidelines.
Challenges: Dental Students
Challenges
• Lack of clinical knowledge
• Lack of vocabulary
• Lack of understanding of
practice needs
• Busy with “real” dental
courses
Opportunities
Challenges: Faculty Members
Challenges
• Already know everything
• Busy
• Don’t “get it”
• Don’t want to look foolish
Opportunities
• Captive audience
• Access to medical library
(online resources)
• Don’t want to look foolish
Challenges: Practicing Dentists
Challenges
• Busy
• Lack access to online
resources
• Economic concerns
Opportunities
• Eager (if paying for CE)
Didactic Teaching First Year EBD Course
Second Year Research Course
Start with a strong rationale
Dental Students
• Just want the “answers”
• Lack Perspective
• Don’t understand that
science/practice changes
Practitioners
• Need to see examples.
• They already practice
EBD…
• Manage fear of change
Strong Rationale
Francis Kelsey, MD
Demanding evidence… she averted a US tragedy.
Carl Henegan, Oxford
Strong Rationale
Julies Back to Sleep slide
Bad things happens
when we don’t look at
evidence
Strong Rationale
Many “Leaks” from research to practice
Aware Accept Target Doable Recall Agree Done
Valid
Research
If 80% achieved at each stage then
0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
Paul Glasziou
Strong Rationale
Teaching Philosophy: Dental Students
• Start early in curriculum
• Easy and Rewarding
• Reinforce for all four years
• Skill development
EBD Taught Early and Often
D1 D2 D3 D4
Didactic EBD/Stats
Clinical Case presentation Adolescent
clinic
Start Early
First-year course
• Classic EBD material
• Asking (PICO)
• Accessing
• Assessing
• Applying
• Just enough stats
• Descriptive (review)
• P-value
• Confidence interval
• Measure of effect
• Diagnostic Test
Weyant’s Rules for Easy and Rewarding EBF
Secondary Sources ONLY (at first)
No wild goose chases
Keep it simple (at first)
Search Strategy
Question (PICO)
Check MeSH
Check for 2nd Sources
Here:
• TRIP
• Cochrane
• ADA EBD
• NGC
STOP
Yes
Search 2nd
Sources
PubMed
(Clinical Queries)
No
PICO – search
strategies for
PubMed
Weyant’s Rules for Teaching Statistics
Formulas = Failure
Less is More
Teach for Consumption
Make it Sticky
Important concepts: Uncertainty
Education is the path from cocky
ignorance to miserable uncertainty. Mark Twain
Important concepts: Lack of Evidence
There is insufficient evidence to determine the
effects of routine scale and polish treatments.
High quality trials conducted in general dental
practice settings with sufficiently long follow-up
periods (five years or more) are required to
address the objectives of this review. Worthington et al., Routine scale and polish for periodontal
health in adults. Cochrane Review, 2013
In three studies, the panel found
no benefit of using prophylaxis
pastes containing fluoride on
the primary or permanent teeth
of children.
Weyant et al., Topical fluoride
recommendations, JADA 2013
Absence of Evidence Evidence of Absence
Important concepts: Clinical Significance
Study size and p-value?
Surrogate endpoints
NNT
EBD Taught Early and Often
D1 D2 D3 D4
Didactic EBD/Stats
Clinical Case presentation Adolescent
clinic
Reinforce in clinic 4 yrs
EBD Taught Early and Often
D1 D2 D3 D4
Didactic EBD/Stats Research Skills Course
[Case Presentation]
Senior Case Presentation
Clinical Case
presentation Adolescent clinic
EBD Clinical
Worksheets EBD Clinical
Worksheets
Reinforce in clinic 4 yrs
Experiential Learning
EBP is a SKILL and requires PRACTICE
Simulated
Cases
POGIL
Sessions Clinical EBD
Worksheets
Small Group Teaching POGIL
Case-Based Learning (HPDP)
Processed Oriented Guided Inquiry Learning
(POGIL)
https://pogil.org/about
Self managed teams
Guided exploration to construct learning
Focuses on higher level thinking skills
POGIL: The Model
Model 1
Model 3
The POGIL Process
Learning Cycle 1. A Question
2. Observation or data collection to
DEVELOP concept.
3. Guide to conclusion
4. Application
Process Skills • Teamwork
• Oral + written communication
• Management
• Problem solving
• Critical Thinking
• Assessment
Small Group Case Based Learning
• SES: High
• Knowledge of oral disease: good
• Medical: Type 1 Diabetes
• Dental: – Regular utilization of dental services.
– No sealants
• Minor Plaque
• No calculus
• Slight gingivitis
• No Caries or restorations
• Occlusion – • under treatment for overjet and
crossbite
ADA Sealant Recommendations
31
ADA Guidelines on
topical fluoride
Clinical Teaching EBD Worksheet
Senior Case
What’s different about teaching graduates (faculty and practicing
dentists)?
Adult Learning Model
Shorter course
Different rationale
More cognitive bias and cognitive dissonance
Where do we go from here…
Full implementation of Evidence-based Program
axiUm
• Risk Assessment
• Diagnostic Codes
• Summary Reports
Faculty training
(coaching)
Policy
changes
37
Robert J. Weyant, DMD, DrPH
Chair, Department of Dental Public Health
University of Pittsburgh School of Dental Medicine
