ACOEM Council on Education and Academic Affairs Guidance on Preparation of Evidence-Based Presentations and Educational Materials ACOEM Council on Education and Academic Affairs

ACOEM Educational Guidance The ACOEM Council on Education and Academic Affairs advocates the creation of clinical and scientific educational content based on the best available evidence Goal is the best functional outcomes for workers/patients Materials, presentations and programs should be clear and transparent about the justification for statements and recommendations Learners should be able to make informed decisions about implementing the recommendations in their practices

Evidence-Based Medicine (EBM): “… is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. …means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” Sackett DL, et al. BMJ. 1996;312:71-80.

The Evidence-Based Approach Uses An objective, graded assessment of the entire body of high quality literature on that topic It is NOT: Selecting an article to support a viewpoint Selecting a few articles for support Reprinting abstracts without critical appraisal

Why Does EBM Matter? Increases audience confidence in the value, objectivity, effectiveness and reproducibility of the tests or procedures Increases transparency Provides a balanced approach Protects patients from ineffective or risky care Increases cost-effectiveness and value

ACOEM First Principles provide a framework for integrating EBM into patient care Ethics Disclose financial, intellectual conflicts of interest Comport with ACOEM Code of Ethics Use evidence based testing and treatment when possible Testing Treatment Invasive treatment Choose the most cost effective of equivalent options Manage to an agreed-on treatment plan Emphasize functional improvement Shared decision making

Aspects of Occupational Health Care for Which Evidence Should be Reviewed Clinical or diagnostic testing and diagnosis Occupational risk factor determination Exposures Prevention Evidence basis for (preventive) regulations Treatment Disability management/return to work Impairment

Additional Issues for which Supporting Evidence is Important Accuracy of symptoms, signs Prevalence Etiology prognosis Clinical assessment (diagnosis/testing) Treatment Harms Cost-effectiveness Disability management Quality of life

Transparency to the audience is key We Encourage Educational Content on the Full Range of Topics Relevant to our Profession ACOEM EBM Guidance is NOT intended to discourage presentation of issues for which there is limited/no evidence basis Discussion of “clinical judgment” and clinical topics for which evidence basis is incomplete is OK when disclosed as such Transparency to the audience is key

Suggestions for Preparation of Presentations and Materials

Types of Evidence to Use in Presentations Evidence-based (EB) High quality clinical practice guidelines Quality systematic reviews and meta-analyses De novo literature search, appraisal and synthesis Evidence informed – above without critical appraisal Listing of literature – annotated descriptive bibliography Professional consensus Experience and/or opinion Regulatory guidance – ideally citing scientific bases for regulations

Evidence Informed Approach Assemble studies you have found on topic of clinical/scientific importance Critically appraise key studies - strengths and weaknesses Consensus recommendations Use in cases of insufficient quality evidence Individual recommendations If consensus not obtained

Practical Guidance for Speakers Clearly inform the audience of the evidence basis (EB) for your presentation as practicable Approach may be adapted to type of presentation Impractical to discuss EB detail for each item in a broad review A summary statement at beginning may suffice in some cases Discuss type of evidence analyses to support your recommendations whenever possible Done by others (meta-analyses, systematic reviews, etc.) Your own critical appraisal of recent literature Cite type, consistency, strength and quality of studies

Provide Listing of Literature with Annotated Bibliography List the references you relied on in standard reference format Ideally, attach a short paragraph describing: The type of study (controlled trial, cohort, case-control, case series, etc.) The objectives of the study Key findings Optional comments on the robustness of the study design and execution, short of a critical appraisal

Practical Guidance for Speakers It is not necessary to review evidence for legal, regulatory, or commonly used consensus documents (e.g., AMA disability guidelines) unless that is the main purpose of the presentation Be cautious (and transparent) when making clinical recommendations based on limited evidence

Thank you for your consideration!