Presentation on theme: "Teaching Evidence-Based Medicine Across the Curriculum"— Presentation transcript:
1 Teaching Evidence-Based Medicine Across the Curriculum Good morning and thank you for joining us for today’s preceptor symposium. Today we will be discussing a topic near and dear to my heart, as you might have guessed given my career choice in drug information. Over the next few hours we will discover the many amazing resources available to all of us as preceptors of the College of Pharmacy. We will learn tricks about google that will allow us to become more effective and efficient in our searches, whether for health-care related topics or to find the best buy on those new shoes or boat. And, we will discover the many applications available on hand held devices for those who may not have continuous ready access to a computer in their clinical practice. I will start, though, by providing you will a brief overview of the COP curriculum specific to developing evidence-based medicine skills so that you have an understanding of what students are taught prior to their arrival in your practice setting.Gundy Sweet, PharmD, FASHPClinical Associate ProfessorUniversity of Michigan, College of Pharmacy
2 ObjectivesProvide a brief overview of the UofM College of Pharmacy curriculum specific to the development of evidence-based medicine skills and conceptsBriefly 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 All done to make the best decision What is EBM?Combine the best evidence from clinically relevant studiesAdd in your clinical expertise to determine if it applies to the individual patientAnd incorporate the patient’s valuesAll done to make the best decisionfor a given situationSackett 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-NexterBut few students have a systematic process to identify the best evidence specific to a given situationWhy is that important?
6 2006: 20,824 journals (medical sciences) 2009: > 679,000 citations added to MedlineToo many sourcesof information
7 2X Information explosion Research information doubles every 10 years Explosion of mis-information
8 Traditional resources often inadequateTextbooks can be outdatedMany books take 1-3 years to get to print
9 1986: Medline available via librarians Readily availablesearch tools1986: Medline available via librariansToday: numerous search tools readily available
10 More knowledgeablepatient30% of adults seeing MD discuss a drug they saw through DTC advertisingalmost ½ of these patients received a RX for the drug
12 1/2 of all withdrawals within 2 years 10% of drugs on market between pulled from market/black box warning added1/2 of all withdrawals within 2 yearsIncrease in number, sophistication,and safety concerns withdrugs/medical interventions
13 Feeling Overwhelmed??? Traditional resources often inadequate Readily availablesearch toolsInformationexplosionMore knowledgeablepatientToo many sourcesof informationIncrease in numberand sophisticationof drugs/medical interventionsDaily need for validinformation
14 How and where are the skills taught? EBM CourseEBM conceptsHow to formulate a clinical questionImportance of clarity of the questionHelps direct you to the most appropriate resourcesHelps ensure communication of a clear responseHow 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 strategyHelps search for the most relevant literature to enhance efficiency and effectivenessThe systematic approach is comprised of 7 steps:BUT… conducting a systematic search requires knowledge of the advantages/disadvantages associated with each type of information resource1. Classify 2. Clarifying information 3. Systematic Search (3o2o1o) 4. Evaluate 5. Apply 6. Communicate 7. Follow-up
16 Where Students Learn About Resources EBM CourseTextbooks and general drug information resourcesSearching the biomedical literatureWhat to use whenPubMed, Embase, Google, IPA, Cochrane, othersUsing the internet - is it reliable?Author credentialsCurrency of the informationSource of fundingAwareness of extensions (.biz .com .edu .gov)External validation of contentWithin this, we teach students the advantages and disadvantages of each source, recognizing that what used to be distinct differences are becoming more grey.Health on the Net Foundation (www.hon.ch/)Established in 1995 in Geneva, SwitzerlandHON code of 8 principles that must be abided by in order to receive this accreditationLook for HON code Icon when evaluating web-sites
17 What about the primary literature? EBM CourseHow to find the primary literatureEfficient and effective searchingHow to read and interpret the primary literatureTerminology (R, DB, PC, DD, etc)Different types of trials (systematic reviews, economic analyses, randomized controlled trials, case reports)Levels of evidenceAppropriate statistical testsAssess all elements of the study, practicing on different published clinical trialsWithin this, we teach students the advantages and disadvantages of each source, recognizing that what used to be distinct differences are becoming more grey.
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?Using these skills is touched upon in the EBM course, but is also revisited throughout the curriculum. Having said that, though, we recognize that this is one of the opportunities for improvement in the curriculum revision. We’ll talk about that more later.
19 Application of EBM Principles P1 YearEBM Course (W)TherapeuticsReinforce identification of best evidenceIntegrate critical appraisal to clinical situationsResearch PrinciplesPractical, application-based course where students write a ‘practice’ research proposalRequires they understand and apply EBM principlesStudy terminologyStudy designSearching primary literatureLearn to logically think through a problem and define a planP2 YearTherapeutics (F/W)Research Principles (W)
20 Application of EBM Principles Research Principles (P2 year)Teach process of defining a logical plan to solving a problemPractical, application-based course where students write a ‘practice’ research proposalRequires that they understand and apply EBM principlesStudy terminology and study design to test a hypothesisSearching the primary literatureLogically think through a problem and define a plan
21 Application of EBM Principles TherapeuticsReinforce identification of best evidence/integrate critical appraisalPcare (IPPE)Discuss patient cases that requires use of best evidenceReinforce primary literature review (journal clubs)PharmD Research ProjectApplication of research principlesEmphasis on process of conducting researchP1 YearEBM Course (W)P3 YearTherapeutics (F/W)Pcare (IPPE)PharmD Research (W)P2 YearTherapeutics (F/W)Research Principles (W)
22 Application of EBM Principles Therapeutics (P2 and P3 years)Reinforce identification of best evidenceIntegrate critical appraisal to given clinical situationsIntroductory Practice Experiences (IPPEs, P3)Discussion of patient cases that includes use of best evidenceReinforcement of reviewing the primary literature2 journal clubs – one group-based and one individual
23 Application of EBM Principles Clinical RotationsManage patients on rotationsReinforce primary literature reviewDrug Information is a required rotationConduct systematic review of topicCritically evaluate literature on a topicRetrieve/analyze/apply DI in practicePharmD Research ProjectApplication of research principlesPharmD SeminarFormal presentationPharmD research or topic reviewRequires application of all EBM skillsSearch/analyze/apply information to a given situationP1 YearEBM Course (W)P2 YearTherapeutics (F/W)Research Principles (W)P4 YearClinical RotationsPharmD ResearchPharmD Seminar
24 Application of EBM Principles Advanced Practice Experiences (APPEs, P4)Management of patients on clinical rotationsReinforcement of reviewing the primary literatureJournal clubsWritten or oral topic reviews (inservices)Required drug information rotationConduct systematic searches for informationRetrieve, analyze and apply drug information in practiceCritically evaluate the literature on a given topic
26 Application of EBM Principles PharmD Research Project (P3-P4 years)Students work with faculty mentor to conduct a research studyEmphasis 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 topicRequires application of all EBM skillsSearch, 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 curriculumDisadvantages:P1 students don’t see the need for these skillsbelieve they already know how to find informationdon’t know what they don’t knowEBM course is taught in isolation of clinical applicationprior to therapeutics and pharmacologyApplication of EBM skills is not adequately reinforced across the curriculum
28 Curriculum revision is an ongoing, dynamic process EBM in New CurriculumP1 YearIntroduce DI skills, resources, terminologyBegin to build a toolboxCurriculum revision is an ongoing, dynamic processP3 YearEBM/ethics coursePcare (IPPE)Therapeutics (F/W)PharmD Research (W)P2 YearEBM: focus on literature evaluation and searching (F)Research Principles (W)Therapeutics (F/W)P4 YearClinical RotationsPharmD ResearchPharmD Seminar
29 Goals with the New Curriculum Maintain existing infrastructure for teaching EBMShift (some) drug information component into the P1 yearProvide students with a toolbox of resources early in trainingAllow for additional time in P2 year to focus on lit evaluationEnsure application of EBM skills builds across the P1-P4 yearsImprove integration of EBM skills into other courses (eg, therapeutics)Provide greater clarity to students for how skills are essential for pharmacy practiceIncrease opportunities for students to practice and apply these skills
30 Goals with the New Curriculum Maximize active learningStudents more involved in learning by DOINGIncrease 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 toINFORMATION RESOURCESUniversity of Michigan, College of PharmacyTAUBMAN LIBRARY RESOURCESRESOURCES BASED ON TYPE OF QUESTION
32 QuestionsWith that as a brief summary of the curriculum behind development of EBM skills, we can delve into the heart of today’s program – how can we all become more effective and efficient at searching for medical literature. It is my pleasure to introduce my colleague, Mark MacEachern, who will share with us the many resources available to all preceptors through the Taubman Library.