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Teaching Evidence-Based Medicine Across the Curriculum Gundy Sweet, PharmD, FASHP Clinical Associate Professor University of Michigan, College of Pharmacy.

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Presentation on theme: "Teaching Evidence-Based Medicine Across the Curriculum Gundy Sweet, PharmD, FASHP Clinical Associate Professor University of Michigan, College of Pharmacy."— Presentation transcript:

1 Teaching Evidence-Based Medicine Across the Curriculum Gundy Sweet, PharmD, FASHP Clinical Associate Professor University of Michigan, College of Pharmacy

2 Objectives Provide a brief overview of the UofM College of Pharmacy curriculum specific to the development of evidence-based medicine skills and concepts Briefly discuss how the curriculum revision process will strive to further develop these skills

3 Evidence-Based Medicine What is it? – EBM is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. – Integrating individual clinical expertise with the best available external clinical evidence from systematic research. Sackett D, 1996

4 What is EBM? Combine the best evidence from clinically relevant studies Add in your clinical expertise to determine if it applies to the individual patient And incorporate the patient’s values All done to make the best decision for a given situation Sackett D, 1996

5 Common Student (mis)Perception You don’t need to teach me this stuff…. I already know how to look for things…. I’m a Gen-Nexter But few students have a systematic process to identify the best evidence specific to a given situation Why is that important?

6 Too many sources of information 2006: 20,824 journals (medical sciences) 2009: > 679,000 citations added to Medline

7 Information explosion Research information doubles every 10 years Explosion of mis-information 2X

8 Traditional resources often inadequate Textbooks can be outdated Many books take 1-3 years to get to print

9 Readily available search tools 1986: Medline available via librarians Today: numerous search tools readily available

10 More knowledgeable patient 30% of adults seeing MD discuss a drug they saw through DTC advertising almost ½ of these patients received a RX for the drug

11 Daily need for valid information

12 Increase in number, sophistication, and safety concerns with drugs/medical interventions 10% of drugs on market between pulled from market/black box warning added 1/2 of all withdrawals within 2 years

13 Feeling Overwhelmed??? Information explosion Increase in number and sophistication of drugs/medical interventions Too many sources of information Traditional resources often inadequate Readily available search tools Daily need for valid information More knowledgeable patient

14 How and where are the skills taught? EBM Course – EBM concepts – How to formulate a clinical question Importance of clarity of the question Helps direct you to the most appropriate resources Helps ensure communication of a clear response – How to apply the systematic approach to handling requests for information

15 What is the Systematic Approach The systematic approach is an integral part of the EBM strategy Helps search for the most relevant literature to enhance efficiency and effectiveness The systematic approach is comprised of 7 steps: BUT… conducting a systematic search requires knowledge of the advantages/disadvantages associated with each type of information resource 1. Classify  2. Clarifying information  3. Systematic Search (3 o  2 o  1 o )  4. Evaluate  5. Apply  6. Communicate  7. Follow-up

16 Where Students Learn About Resources EBM Course – Textbooks and general drug information resources – Searching the biomedical literature What to use when – PubMed, Embase, Google, IPA, Cochrane, others – Using the internet - is it reliable? Author credentials Currency of the information Source of funding Awareness of extensions (.biz.com.edu.gov) External validation of content

17 What about the primary literature? EBM Course – How to find the primary literature Efficient and effective searching – How to read and interpret the primary literature Terminology (R, DB, PC, DD, etc) Different types of trials (systematic reviews, economic analyses, randomized controlled trials, case reports) Levels of evidence Appropriate statistical tests Assess all elements of the study, practicing on different published clinical trials

18 Using EBM Skills EBM Course and beyond – How do I apply the information? Does the information found apply to the clinical situation (indication, age group, etc)? Are the results clinically important (and not just statistically significant)? – Is the information found sufficient to answer the question? – How should I communicate the information? – Are there any ethical considerations to take into account?

19 Application of EBM Principles P1 Year EBM Course (W) P2 Year Therapeutics (F/W) Research Principles (W) Therapeutics Reinforce identification of best evidence Integrate critical appraisal to clinical situations Research Principles Practical, application-based course where students write a ‘practice’ research proposal Requires they understand and apply EBM principles Study terminology Study design Searching primary literature Learn to logically think through a problem and define a plan

20 Application of EBM Principles Research Principles (P2 year) – Teach process of defining a logical plan to solving a problem – Practical, application-based course where students write a ‘practice’ research proposal – Requires that they understand and apply EBM principles Study terminology and study design to test a hypothesis Searching the primary literature Logically think through a problem and define a plan

21 Application of EBM Principles P1 Year EBM Course (W) P3 Year Therapeutics (F/W) Pcare (IPPE) PharmD Research (W) P2 Year Therapeutics (F/W) Research Principles (W) Therapeutics Reinforce identification of best evidence/integrate critical appraisal Pcare (IPPE) Discuss patient cases that requires use of best evidence Reinforce primary literature review (journal clubs) PharmD Research Project Application of research principles Emphasis on process of conducting research

22 Application of EBM Principles Therapeutics (P2 and P3 years) – Reinforce identification of best evidence – Integrate critical appraisal to given clinical situations Introductory Practice Experiences (IPPEs, P3) – Discussion of patient cases that includes use of best evidence – Reinforcement of reviewing the primary literature 2 journal clubs – one group-based and one individual

23 Application of EBM Principles P1 Year EBM Course (W) P2 Year Therapeutics (F/W) Research Principles (W) P4 Year Clinical Rotations PharmD Research PharmD Seminar Clinical Rotations Manage patients on rotations Reinforce primary literature review Drug Information is a required rotation Conduct systematic review of topic Critically evaluate literature on a topic Retrieve/analyze/apply DI in practice PharmD Research Project Application of research principles PharmD Seminar Formal presentation PharmD research or topic review Requires application of all EBM skills Search/analyze/apply information to a given situation

24 Application of EBM Principles Advanced Practice Experiences (APPEs, P4) – Management of patients on clinical rotations – Reinforcement of reviewing the primary literature Journal clubs Written or oral topic reviews (inservices) – Required drug information rotation Conduct systematic searches for information Retrieve, analyze and apply drug information in practice Critically evaluate the literature on a given topic

25 Application of EBM Principles P1 Year EBM Course (W) P3 Year Pcare (IPPE) Therapeutics (F/W) PharmD Research (W) P2 Year Therapeutics (F/W) Research Principles (W) P4 Year Clinical Rotations PharmD Research PharmD Seminar

26 Application of EBM Principles PharmD Research Project (P3-P4 years) – Students work with faculty mentor to conduct a research study – Emphasis is on the process of conducting research (defining a logical plan) PharmD Seminar (P4 year) – Formal presentation of either their PharmD research or a clinical review of a topic – Requires application of all EBM skills Search, analyze, and apply information to a given situation

27 What does curriculum achieve? Advantage: – EBM skills taught early (P1 year) – Skills are revisited throughout the curriculum Disadvantages: – P1 students don’t see the need for these skills believe they already know how to find information don’t know what they don’t know – EBM course is taught in isolation of clinical application prior to therapeutics and pharmacology – Application of EBM skills is not adequately reinforced across the curriculum

28 EBM in New Curriculum P1 Year Introduce DI skills, resources, terminology Begin to build a toolbox P3 Year EBM/ethics course Pcare (IPPE) Therapeutics (F/W) PharmD Research (W) P2 Year EBM: focus on literature evaluation and searching (F) Research Principles (W) Therapeutics (F/W) P4 Year Clinical Rotations PharmD Research PharmD Seminar Curriculum revision is an ongoing, dynamic process

29 Goals with the New Curriculum Maintain existing infrastructure for teaching EBM Shift (some) drug information component into the P1 year – Provide students with a toolbox of resources early in training – Allow for additional time in P2 year to focus on lit evaluation Ensure application of EBM skills builds across the P1-P4 years Improve integration of EBM skills into other courses (eg, therapeutics) – Provide greater clarity to students for how skills are essential for pharmacy practice – Increase opportunities for students to practice and apply these skills

30 Goals with the New Curriculum Maximize active learning – Students more involved in learning by DOING Increase opportunities in all courses for students to …. – not just KNOW the information but …. – to have the ability to APPLY information in practice

31 In your packet is a document for your toolbox… A Guide to INFORMATION RESOURCES University of Michigan, College of Pharmacy TAUBMAN LIBRARY RESOURCES RESOURCES BASED ON TYPE OF QUESTION

32 Questions


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