Teaching Evidence-Based Medicine Across the Curriculum

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  • 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.
  • Within this, we teach students the advantages and disadvantages of each source, recognizing that what used to be distinct differences are becoming more grey.
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  • Within this, we teach students the advantages and disadvantages of each source, recognizing that what used to be distinct differences are becoming more grey.
  • 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.
  • With 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.
  • Teaching Evidence-Based Medicine Across the Curriculum

    1. 1. Teaching Evidence-Based Medicine Across the Curriculum Gundy Sweet, PharmD, FASHP Clinical Associate Professor University of Michigan, College of Pharmacy
    2. 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. 3. 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
    4. 4. 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?
    5. 5. Too many sources of information • 2006: 20,824 journals (medical sciences) •2009: > 679,000 citations added to Medline
    6. 6. Information explosion • Research information doubles every 10 years • Explosion of mis-information 2X
    7. 7. Traditional resources often inadequate • Textbooks can be outdated • Many books take 1-3 years to get to print
    8. 8. Readily available search tools • 1986: Medline available via librarians • Today: numerous search tools readily available
    9. 9. 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
    10. 10. Daily need for valid information
    11. 11. Increase in number, sophistication, and safety concerns with drugs/medical interventions • 10% of drugs on market between 1975-1999 pulled from market/black box warning added • 1/2 of all withdrawals within 2 years
    12. 12. 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
    13. 13. 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
    14. 14. 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 (3o2o1o)  4. Evaluate  5. Apply  6. Communicate  7. Follow-up
    15. 15. 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
    16. 16. 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
    17. 17. 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?
    18. 18. 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
    19. 19. 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
    20. 20. 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
    21. 21. 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
    22. 22. 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
    23. 23. 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
    24. 24. 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
    25. 25. Questions

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