1. From McGraw-Hill Medical Presented by: Linh Ngu & John Obligacion
Evidence-Based Clinical Practice: Online Resources to Teach, Learn, and Apply
From McGraw-Hill Medical
Presented by: Linh Ngu & John Obligacion

2. Agenda Fundamentals of evidence-based medicine/practice (EBM/EBP)
Importance of EBM for patient care
EBM and Resources in the Hospital
Sources of Medical Literature

3. Fundamentals of Evidence-Based Medicine
Awareness and understanding of clinical research evidence (i.e. medical literature)
Ensuring that the evidence being consulted is trustworthy and grounded in best practice
Creating various management strategies that consider patient’s unique predicament, values, and preferences
These are the key elements that should be known about EBM:
Users need to fully understand the medical literature being referenced. Be able to interpret the readings. Compare the readings
Not all evidence is equal. Is the source trustworthy? Is it grounded in best practice?
Consider the patient’s unique situation, values, and preferences. What is the best treatment based on these conditions?

4. Importance of EBM in Patient Care
Clinicians gain understanding of patient’s personal circumstances
Improves patient adherence to treatment
Treatment decisions that are consistent with principles guiding evidence-based practice
EBM has become essential in patience care:
Forces clinicians to understand the patient’s personal circumstances and get to know the patient
When patients can select their treatment option, it improves adherence to the treatment
Patients receive treatment that is consistent with principles guiding EBP. Overall, this leads to better outcomes and care

5. EBM in the Hospital
Many clinicians need to be taught how to read, criticize, and apply medical literature
When they are not able to make a reasonable criticism on their readings, they rely on reviews. Reviews generally provide biased results
One of the main barriers to implementing EBM in organizations is education. Many clinicians need to be taught how to read, criticize, and apply medical literature. If they are not able to make reasonable criticisms and comparisons within their research, they start to rely on reviews. Reviews generally provide biased results. Clinicians need to get into the habit of consulting more than one medical literature source.

6. Tools in the Hospital
How can clinicians acquire the necessary skills for optimal evidence-based practice?
What EBM resources are available for them to find answers?
There are a couple of things that organizations can do to help their clinicians with EBP:
Provide tools to educate their clinicians on EBP. Some organizations may have a course that teaches EBP. Additionally, there are also learning materials available to guide them through the process.
Secondly, most organizations purchase content that fulfills the different levels of the evidence hierarchy. Journals, databases, systematic reviews, etc.

7. JAMAevidence from McGraw-Hill and JAMA
An online resource that provides the tools needed for learning, teaching, and applying evidence-based medicine for:
Clinicians
Researchers
Health Professionals
Students
Residents
With the goal of educating clinicians about EBM, McGraw-Hill has partnered with JAMA to create JAMAevidence, an online resource that provides tools needed for learning, teaching, and applying EBM. This is a great resource not only for clinicians, but also researchers, health professionals, students, and residents.

8. Content from Leading EBM Texts
Users’ Guides to the Medical Literature
3rd ed (Guyatt)
Foundations through to moving evidence into action
The Rational Clinical Examination (Simel)
Case-based approach to topics of interest with accompanying teaching/learning slides
Correct way to learn medical history and physical examination
Care at the Close of Life (McPhee)
Addresses issues in palliative care
Integrates support as part of the trajectory of care
The site provides access to these three leading textbooks in EBM.
First and foremost, we have the Users’ Guide to Medical Literature. The lead author is Gordon Guyatt, from McMaster University. It started as the Users’ Guides Series in JAMA in the 1980s. They eventually were stitched together to form this book in Throughout the years have been updated for clinical relevance and best practice. The book starts with foundations and takes the users through moving to evidence into action.
Partnered with the Users’ Guide is The Rational Clinical Examination by lead authors David Simel from Duke and Drummond Rennie from UCSF. This is a case book featuring topics of interest with accompanying slides for teaching and learning. It provides a careful systematic approach to assess the accuracy of the patients medical history and clinical examination
Finally, Care at the Close of Life by lead authors Stephen McPhee and team out of UCSF focuses on the softer side of medicine. It addresses issues in palliative care and integrates support as part of the trajectory of care

9. Online-Only Material Education Guides
Downloadable slides to help teach/learn core concepts from the texts
JAMAevidence provides online-only material that users would not have access to if they purchased the print book.
This includes education guides – downloadable slides to help teach/learn core concepts from the textbooks

10. Online-Only Material Calculators
Enhance the user’s understanding of statistical and mathematical relationships in EBM
Estimate risk reduction, harm, and diagnostic values
Calculators help users understand statistical and mathematical relationships in EBM. They can estimate risk reduction, harm, and diagnostic values

11. Online-Only Material Learning Tools
Help users synthesize information from their readings
Learning tools such as critical appraisal worksheets and information cycle worksheets help users synthesize the information from their readings

12. Online-Only Material Podcasts
Listen to leaders in EBM discuss core issues
Recorded and produced by JAMA editors for JAMAevidence
Updated monthly
The JAMA editors produce podcasts specifically to be posted on JAMAevidence. Users can listen to leaders in EBM discuss core issues each month

13. What are the EBM Resources?
Summaries and Guidelines
Online summaries at a topic level
Databases of clinical practice guidelines
Preappraised research
Synopses of systematic reviews (e.g. 1-page summaries)
Systematic reviews
Synopses of studies (e.g. expert commentary, McMasterPlus, etc)
Nonpreappraised research
Filtered studies (e.g. MEDLINE)
Unfiltered studies (e.g. clinical queries in PubMed)
Federated searches
All layers of resources searched at once
So we’ve shown you a resource that can help users become educated in EBM. The next step is to look at what types of medical literature is available to them. These resources are listed on this slide based on the hierarchy of evidence, starting at the highest level:
Summaries and Guidelines – point-of-care reference summaries, clinical practice guidelines (e.g. National Guideline Clearinghouse)
Preappraised research – 1-page summaries, systematic reviews, expert commentary
Nonpreappraised research – filtered studies, unfiltered studies (e.g. clinical queries)
Federated searches – search across the entire hierarchy of evidence at one time. (e.g. TRIP database)

14. EBM Resources from McGraw-Hill
These are EBM resources from McGraw-Hill.
This slide features our Access suite of products with the flagship being AccessMedicine, which provides content across many medical specialties. Specialty-specific Access products are also available. Furthermore, there is McGraw-Hill’s point-of-care question and answer database called ClinicalAccess, that users can search to get a quick answer to their clinical queries.

15. AccessMedicine & ClinicalAccess
80+ Premier textbooks
updated online before new editions publish to ensure clinically relevant and current content
2-minute Medicine
Summaries of high-impact and current medical literature
Access to McMaster Premium Literature Service
Search current, scientifically-relevant clinical evidence
AccessMedicine and ClinicalAccess can help users with their medical literature research.
AccessMedicine features more than 80 premier textbooks, many of which are updated online before new editions are published to ensure content is current and clinical relevant
We also recently introduced 2-minute medicine to AccessMedicine. This content has been licensed to provide users with concise, curated, and authoritative medical reports of breaking medical literature. Reports come out daily
ClinicalAccess allows clinicians to use the McMaster Premium Literature Service called McMaster Plus. Users can search current, scientifically-relevant clinical evidence that has been rated by the McMaster Online Rating of Evidence (MORE) system

16. Summary
EBM is a rigorous process that requires fundamental understanding and practice. Consider what resources are needed in your organization to teach, learn, and apply EBM

17. Questions?
John Obligacion California (south of Fresno), Arizona, Nevada, New Mexico Phone: Linh Ngu California (Fresno and north) Alaska, Colorado, Idaho, Montana, Oregon, Utah, Washington, Wyoming Phone: