06.09 - Appraising the Literature

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Teaching and Assessing Clinical Skills

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University of Michigan

Teaching and Assessing Clinical Skills

122 оценки

The purpose of this course is to improve feedback, clinical teaching, and assessment of clinical skills.

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How to Effectively Incorporate Evidence Based Medicine Teaching into the Clinical Environment

06.00 - Introduction: Evidence Based Medicine in Clinical Teaching0:49

06.01 - Introduction: What is Evidence Based Medicine?2:22

06.02 - Adult Learning and Overview1:33

06.03 - How to form a PICO question2:13

06.04 - Forming a Question with a Resident3:23

06.05 - Resident Searching the Literature2:56

06.06 - Debrief of Resident Inpatient EBM Teaching - Forming a Question4:00

06.07 - Forming a question and searching the literature with a student14:12

06.08 - Debrief of student outpatient EBM teaching - forming a question4:02

06.09 - Appraising the Literature2:31

06.10 - Resident Appraising the Literature6:06

06.11 - Debrief of resident inpatient EBM teaching - appraising the literature3:56

06.12 - Student appraising the literature10:33

06.13 - Debrief of student outpatient EBM teaching - appraising the literature4:21

06.14 - Implementation and apply the evidence0:37

06.15 - Faculty tips for how to use EBM in the inpatient setting5:03

06.16 - Faculty tips for how to use EBM in the outpatient setting12:57

06.17 - Putting It All Together0:44

Познакомьтесь с преподавателями

Sally Santen, M.D., Ph.D.
Associate Professor - Emergency Medicine
University of Michigan Medical School

Technology has exploded and

provided us access to more information than ever before,

requiring us to scrutinize the information that we find and assess whether or

not our sources have provided us with good versus poor quality information.

Secondary sources such as the Cochran Library,

The Database of Abstracts of Reviews of Effectiveness, Clinical Evidence online,

and ACP Journal Club, can help guide us in the assessment of validity.

When you find evidence, you need to assess the validity,

the results, the relevance, the impact, and how well it applies to the clinical

case before using it to make a decision in a clinical context.

Instructors need to emphasize to learners that randomized control trials and

systematic reviews are not always a good quality.

With a randomized control trial,

you have to ask the following questions, is the study randomized?

Was it blinded?

Were the groups treated equally?

Were the subjects analyzed in groups that they were randomized to?

Was follow-up complete?

With systematic review, special attention needs to be paid to types of articles,

the databases used, the search criteria, the completeness of the search,

the inclusion, exclusion criteria, and homogeneity.

When looking at results, certain things need to be taken into consideration.

This part can involve some math and may be confusing to learners.

It is important to explain the clinical relevance and

talk trainees through the math equations and the thought processes.

Instructors must help learners realize,

it's not just memorizing the math equations, it's using them.

Useful things to understand and know how to calculate include relative risks,

odd ratios, number needed to treat, sensitivity,

specificity, negative predictive value, positive predictive value.

Finally, relevance must be assess,

you need to ask yourself to the result supplied to my patient.

From the above step, trainees can assess the quality of evidence.

After critically appraising the evidence, you need to assess at the characteristics

of the study applied to your real life patient.

Trainees should be encouraged to determine if their patient characteristics

are close enough to those found in their evidence based medicine search.

They then misuse clinical judgement to see if they can apply the information

that was found to their patient.

Trainees at this step should be encouraged to assess the patient's baseline risk,

assess the benefit to the patient using number needed to treat,

weigh the benefit versus the harm, and taken to account patient preference.

In the end, it should be emphasize to learners that evidence does not exist

to every clinical question, and if there's clinical uncertainty,

clinical judgement must take over.

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