Practicing evidence-based medicine is widely regarded both as best clinical practice, and as the cornerstone of meeting the ACGME competencies in Practice-Based Learning and Improvement. Training programs recognize the need to teach the skills of EBM and yet struggle with readily available content and guidance on putting together a curriculum. Time frames for delivering curricula in residency can be very tight, often restricted to scattered one hour conferences. This book provides a modular curriculum structure for instructors, with each topic area taking up one section, or one hour of instructional time.
Developed over the past 14 years as an introductory course for interns in the internal medicine residency program at Duke, the curriculum will cover core content areas in evidence-based medicine and best teaching practices for them and skills such as literature searching and applying evidence to patients. Most importantly, it will center on actual patient questions and use current literature as examples that instructors can use as teaching exercises. There will also be ample diagrams that have been shown to be effective with learners and each module will include a video tutorial of a sample teaching session, including visual aids and small group teaching techniques. The curriculum can be implemented in any time frame necessary, compressed or longitudinal, to a variety of learners.
This is an ideal guide for residency program directors and core faculty, either within internal medicine or more broadly in family medicine, pediatrics, surgery, OB-gyn, as well as medical school faculty for use with students.
Author(s): Daniella A. Zipkin
Publisher: Springer
Year: 2022
Language: English
Pages: 198
City: Cham
Acknowledgments
Contents
Contributors
1: How To Use This Book
Introduction
Background and Rationale for Evidence-Based Medicine Teaching
Steps in Building your EBM Curriculum [7]
Sample Curricular Goals and Objectives
Classic EBM Domains and Content Areas
EBM Curriculum Methods
Selecting Good Teaching Papers
Putting it All Together
References
2: Clinical Question and Study Design
The Evidence Cycle, and Asking a Clinical Question
Objectives
Anatomy of a Question
Deciding on the Type of Question
Where to Find Answers
Study Design
Objectives
Case Series
Cross-Sectional Studies
Cohort Studies
Case-Control Studies
Clinical Trials (Gold Standard: Randomized Controlled Trials)
Bias and Random Error
References
3: Searching the Medical Literature
Topic Outline
Introduction
Types of Resources
Primary Journal Literature
Pre-appraised Resources
Summary Resources
Apps and Other New Tools
PubMed Core Tips, Searching PubMed Efficiently
Tip 1: Start with a Focused Clinical Question
Tip 2: Search Using a Combination of Subject Headings and Keywords
Tip 3: Combine Terms with ANDs and ORs
Tip 4: Narrow Your Search to the Best Study Design for the Type of Question You Are Asking
Tip 5: Selecting an Article
Streamlining Your Searches
Working with Results: Google Scholar, Scopus, and Other Primary Resources
Saving Your Work
4: Therapy: Assessing the Value of Clinical Interventions
Framing the Question
Anatomy of a Question
Assessing the Risk of Bias
Truncated Trials: Trials Stopped Early for Benefit
Error in Clinical Trials
Interpreting One Small Study in the Universe of Data
Teach It!!
Therapy Math
Understanding the Magnitude of the Results
Basic Terms
Measures of Association [10, 11]
ARR vs. RRR
Why Does NNT = 1/ARR?
How Precise Is the Treatment Effect?
The p-Value and How It Relates to the Confidence Interval
Applying and Communicating Results of Clinical Trials to Your Patient
Case Scenario
Estimating the Patient-Specific Risk Reduction
Resolution of our Case
How Should Results Be Communicated to the Patient?
What if My Patient Has Only Been Studied as a Subgroup of a Trial?
Shared Decision Making
Appendix: Worksheets
Worksheet 4.0: Critical Appraisal for a Therapy Study
Therapy Critical Appraisal Worksheet (Randomized Controlled Trials)
Worksheet 4.1: Therapy Exercise, Blank Sample
Therapy Worksheet
Worksheet 4.2: Therapy Exercise, Internal Medicine Sample
Therapy Worksheet: Internal Medicine Sample
Worksheet 4.3: Applying Results Exercise, Internal Medicine Sample
Applying Results to Patients Worksheet: Internal Medicine
References
5: Non-inferiority Study Designs
Non-inferiority Study Designs
The Non-inferiority Margin: Just How Much “Worse” Can You Be and Still Be Considered “Not Worse Than”?
What Are the Results and How Do We Interpret Them?
Risk of Bias in Non-inferiority Studies
Appendix
References
6: Harm and Causation: Assessing the Value of Studies of Harm
Study Design for Harm or Causation Questions
Confounding Variables
Assessing Bias in Studies of Harm or Causation
Harm Math and the Magnitude of Association
Definitions
Appendix
References
7: Diagnostic Testing: Assessing the Value of Studies of Diagnostic Tests
Diagnostic Testing Study Design and Sources of Bias
Pretest Probability
Understanding the Results or Diagnostic Testing Math
A Diagnostic Dilemma
Prevalence
Sensitivity and Specificity
Predictive Value (for this Population, with this Prevalence)
Back to Likelihood Ratios!!
For the Mathematically Inclined
Use of Tests in Sequence
Appendix
References
8: Screening
Introduction
Sources of Bias in Studies of Screening
Lead Time Bias
Length Time Bias
Volunteerism Bias
Balancing Benefits and Harms in Screening
References
9: Prognosis
Introduction
Sources of Bias in Studies of Prognosis
Clinical Prediction Rules
Prognosis Math
References
10: Systematic Reviews and Meta-analysis
Introduction
Systematic Review Methodology
Systematic Reviews: Risk of Bias in Identifying Studies
Magnitude of Results and Heterogeneity
Special Analyses
Appendix
References
11: Shared Decision Making
Introduction
Develop a Script
Assess the Patient’s Context
Assess Benefits and Harms
Integrate Patient Preferences
Reach a Decision
From Theory to Action
Appendix
Shared Decision Making Worksheets
Worksheet Template
Worksheet Example: Searching the Literature
Worksheet Example: Causation/Harm
Worksheet Example: Diagnosis
Worksheet Example: Screening
Worksheet Example: Therapy
Worksheet Example: Prognosis
Worksheet Example: Systematic Reviews
Worksheet Example: Non-inferiority
Worksheet Example: Learner Assessment
References
Index
