1. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides1 Medical Teaching through PBL+EBM Experience in CCH Lai Yu-Jia Chief, Department of Community Medicine, CCH Staff, Department of Evidence-based Medicine, CCH LAIYUJIA@ms1.hinet.net

2. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides2 Changhua Christina Hospital- est. 1896 We integrated EBM since 1996

3. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides3 Part 5-1 Basic theory ․ Part 5-2 CCH experience Part 5-3 Practice PBL+EBM Part 5-4 Outcome measurement Part 5-5 Our vision and commitment

4. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides4 Learning vector

5. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides5 UK: Centre for Evidence-Based Medicine http://www.cebm.net/index.asp

6. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides6 Process of PBL+EBM Formulate a problem list. PBL discussion : Facts / Hypothesis / Need to know / Learning objectives. Formulating an answerable clinical question based on PICO ( patient, intervention, comparison, outcome ). Start EBM process. Final check up after paper work is finished.

7. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides7 Part 5-2 CCH experience Part 5-1 Basic theory ․ Part 5-3 Practice PBL+EBM Part 5-4 Outcome measurement Part 5-5 Our vision and commitment

8. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides8 EBM 推廣與教育訓練 推展機構文化 ： 1996 ， 院長與賴鈺嘉主任開始推廣，派員到英國 EBMC 學習，成立核心 EBM 推動小組 每位主治醫師配置一台 PC ，可直接上網資料查詢 設置 EBM 網站，辦各式工作坊與全國研討會，培訓 EBM 種子教師，擴展至 EBN 、 EBD 、 EBMH 、 EBHC………. 成立 EBM 中心，充實 EBM 期刊、圖書資料，教學空間設 備，與圖書館結合 2002 ，全院 VS 繳交 EBM 作業一份，院長獎金一萬 2003 ， PGY1 規定 8 小時 EBM 訓練， EBM 中心堅持以小組 學習工作坊方式進行，以求增強學習效果。 2004 ，晉升委員會規定 R3 升 R4 需具備 EBM 工作坊通過證 書。 UGY 學員 8 小時的 EBM 基礎工作坊訓練。 2005 ，配合彰基醫學教育卓越計畫，鼓勵各科部落實 EBM 於臨床實務。

9. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides9 國外受訓 + 院內推展

10. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides10 EBM 中心教育活動統計 年度項目 場次受訓人數 95 年師資培育 EBM130 一般教育基礎教育 13174 一般教育 CAT967 一般教育 讀書會 856 94 年師資培育 PBL366 師資培育 EBM118 一般教育基礎教育 14122 93 年一般教育基礎教育 14142 合計 63675

11. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides11 Part 5-3 Practice PBL+EBM Part 5-1 Basic theory Part 5-2 CCH experience ․ Part 5-4 Outcome measurement Part 5-5 Our vision and commitment

12. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides12 Clinical scenario from chart We put PBL followed by EBM in the out- patient setting at PGY1 ( Post-graduate year 1 ) stage. First, they select a clinical scenario from chart record.

13. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides13 Formulate a problem list Second, they formulate a problem list. Resident physicians generate many patient-related questions in the outpatient setting, but rarely answer them.

14. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides14 Focused clinical question Residents completed a well focused clinical question after their clinical scenario exercise. They will than attempt to answer the specific question based on the process of EBM.

15. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides15 Part 5-4 Outcome measurement Part 5-1 Basic theory Part 5-2 CCH experience Part 5-3 Practice PBL+EBM ․ Part 5-5 Our vision and commitment

16. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides16 Patients for PBL discussion In 2004, 43 residents completed our training program. Patients without cancer diagnosis are most likely to be selected for PBL discussion (88.4%).

17. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides17 Question - Database Almost all of the 43 residents are able to formulate a well built clinical question. Treatment is the most common type of clinical question (81.4%). Database used for answering the clinical question are Medline (46.5%) and PubMed (41.9%) accordingly.

18. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides18 RCT - NNT For critical appraisal skill training, most of them select RCT ( Randomized control trail ) type of paper (62.8%). Near half of them can calculate NNT ( Number needed to treat ) (48.8%).

19. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides19 Part 5-5 Vision and commitment Part 5-1 Basic theory Part 5-2 CCH experience Part 5-3 Practice PBL+EBM Part 5-4 Outcome measurement ․

20. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides20 協助國衛院發展 [ 實證臨床指引平台 ]

21. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides21 自 91 年 7 月份起於中區健保局發展實證醫學專區

22. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides22 Evidence practice - talk with BMJ editors 4/12 UpToDate 與彰基 2000 門診醫囑連結 提供快速連結，減少搜尋時間

23. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides23 Conclusion E : Evidence Q : Question PBL+EBM(+CPG+CQI)

24. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides24 Evidence for relationship

25. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides25 Question from communication

26. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides26 In conclusion: PBL+EBM (+CPG+CQI) PBL followed by EBM can offer as an educational tool for resident’s outpatient care training at least in tertiary teaching hospitals

27. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides27 Learning vector

28. 2007/04/27- 全院演講 -LaiYuJia PBL+EBM-28 slides28 Evidence-based health care Basic theory CCH experience Practice PBL+EBM Outcome measurement Our vision and commitment