Integration of EMB Tools and Curriculum

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  • http://www.onlineplus.com.tw/Events/080916.html http://www.mmh.org.tw/taitam/medical_edu/mmhedu/edu_20080916.htm
  • Integration of EMB Tools and Curriculum

    1. 1. 實證工具 與 教學課程 之 結合 長庚醫院.基隆分院 風濕過敏免疫科.實證中心 楊宗翰醫師
    2. 2. <ul><li>Clinical Medicine </li></ul><ul><li>實證工具 </li></ul><ul><li>教學課程 </li></ul><ul><li>結合 </li></ul><ul><li>總結 </li></ul>
    3. 3. 教學課程 - Clinical Medicine <ul><li>背 </li></ul><ul><li>懂 </li></ul>
    4. 4. 教學課程 - Clinical Medicine 用
    5. 5. Clinical Medicine <ul><li>Student </li></ul><ul><li>Clerk </li></ul><ul><li>Intern </li></ul><ul><li>Resident </li></ul><ul><li>Fellow </li></ul><ul><li>Reciting </li></ul><ul><li>Applying </li></ul><ul><li>Studying </li></ul>
    6. 6. Clinical Medicine Data Subjective Objecitive Hypothesis Generation & Diagnosis Confirm Diagnosis by testing Plan in Treatment & Advice Write present illness to suggest the diagnosis and differential Write assessment In diagnosis & treatment Look it up and present it to seek other’s opinion
    7. 7. Clinical Medicine Comprehension, Application Analysis, Synthesis, Evaluation Collection Analysis Synthesis Evaluation Value, Cost-Benefit Experience, Intuition, Bias Evidence Knowledge Reasoning
    8. 8. <ul><li>Clinical Medicine </li></ul><ul><li>實證工具 </li></ul><ul><li>教學課程 </li></ul><ul><li>結合 </li></ul><ul><li>總結 </li></ul>
    9. 9. 實證工具 – 生活五步驟 <ul><li>問: Question Log Book </li></ul><ul><li>查: Databases </li></ul><ul><li>讀: Appraisal Tools & Calculators </li></ul><ul><li>用: Biological & Pathophysiological Knowledge </li></ul><ul><li>審:… </li></ul>
    10. 10. 問: Question Log Book
    11. 12. 查: Databases <ul><li>Background </li></ul><ul><li>Basics: Books </li></ul><ul><li>Drugs: Micromedex </li></ul><ul><li>Clinical Medicine: </li></ul><ul><ul><li>Books </li></ul></ul><ul><ul><li>Dynamed </li></ul></ul><ul><ul><li>MD Consults </li></ul></ul><ul><ul><li>Uptodate </li></ul></ul><ul><li>Foreground </li></ul><ul><li>Secondary </li></ul><ul><ul><li>EBM reviews, … </li></ul></ul><ul><li>Primary </li></ul><ul><ul><li>CENTRAL </li></ul></ul><ul><ul><li>PudMed/Medline </li></ul></ul><ul><ul><li>EMBASE, CIHNAL </li></ul></ul>
    12. 13. 讀: Appraisal Tools & Calculators <ul><li>Appraisal Tools </li></ul><ul><ul><li>Type of Articles Dx/Rx/Ex/Px </li></ul></ul><ul><ul><li>CASP </li></ul></ul><ul><ul><li>JAMA - Worksheets </li></ul></ul><ul><ul><li>Oxford – RAMboo </li></ul></ul><ul><ul><li>… </li></ul></ul><ul><li>Calculators </li></ul><ul><ul><li>Risk Calculators </li></ul></ul><ul><ul><ul><li>Stroke </li></ul></ul></ul><ul><ul><ul><li>CV/MI </li></ul></ul></ul><ul><ul><ul><li>Osteoporotic fracture </li></ul></ul></ul><ul><ul><li>Stat Calculators </li></ul></ul><ul><ul><ul><li>95% CI & p-value </li></ul></ul></ul><ul><ul><ul><li>NNT/NNH </li></ul></ul></ul><ul><ul><ul><li>Sen/Spe/PPV/NPV/LR </li></ul></ul></ul>
    13. 14. 用 & 審 <ul><li>Communication </li></ul><ul><li>Hx/PE, Reasoning </li></ul><ul><li>patient value </li></ul><ul><li>preference </li></ul>Biology & Pathophysiology Evidence Expectation Expertise
    14. 15. <ul><li>Clinical Medicine </li></ul><ul><li>實證工具 </li></ul><ul><li>教學課程 </li></ul><ul><li>結合 </li></ul><ul><li>總結 </li></ul>
    15. 16. 122 activities / a mo @ KCGMH
    16. 17. Schedules <ul><li>Morning Meeting </li></ul><ul><ul><li>Case x 3, M&M x1, Lecture x1 </li></ul></ul><ul><li>Block </li></ul><ul><ul><li>EKG, CXR, ABG, GI (NG, digital, LFT) </li></ul></ul><ul><li>OPDs </li></ul><ul><li>Rounds </li></ul>
    17. 18. <ul><li>Clinical Medicine </li></ul><ul><li>實證工具 </li></ul><ul><li>教學課程 </li></ul><ul><li>結合 </li></ul><ul><li>總結 </li></ul>
    18. 19.
    19. 20.
    20. 21. Lectures
    21. 22. Rounds
    22. 23. Meetings
    23. 24. Summary <ul><li>Clinical Medicine </li></ul><ul><li>實證工具 </li></ul><ul><li>教學課程 </li></ul><ul><li>結合 </li></ul><ul><li>總結 </li></ul>
    24. 25. Intern <ul><li>Basic Clinical Skills (History, PE) </li></ul><ul><li>Basic Knowledge (Anatomy, Physiology, Pathology, Pathophysiology, *ologies) </li></ul><ul><li>Use “Current Best Evidence” to care our patients. </li></ul><ul><li>Integration of Evidence, Expertise, Expectation. </li></ul><ul><li>5 steps </li></ul><ul><ul><li>問,查,讀,用,審 </li></ul></ul>
    25. 26. Resident <ul><li>The center of clinical medicine </li></ul><ul><ul><li>Reasoning , Evidence , & Knowledge </li></ul></ul><ul><li>P resent your cases </li></ul><ul><ul><li>34 items in 5 minutes </li></ul></ul><ul><li>Asking questions about your cases </li></ul><ul><ul><li>P.I.C.O. </li></ul></ul><ul><li>Finding answers </li></ul><ul><ul><li>Secondary > Primary sources </li></ul></ul>
    26. 27. Fellow <ul><li>Search </li></ul><ul><ul><li>Using Medline or Clinical queries </li></ul></ul><ul><ul><li>MeSH or keywords </li></ul></ul><ul><ul><li>Focus or explode </li></ul></ul><ul><ul><li>Limit and combination </li></ul></ul><ul><ul><li>Boolean search </li></ul></ul><ul><li>Appraise </li></ul><ul><ul><li>Critical appraisal. </li></ul></ul><ul><ul><li>Knowledge of Epi & Biostat </li></ul></ul><ul><li>Browse the Journal. </li></ul><ul><ul><li>Up to minutes … </li></ul></ul><ul><li>Journal Club </li></ul>
    27. 28. Teachers <ul><li>Using their eyes to watch … </li></ul><ul><li>Using their minds to feel … </li></ul><ul><li>Using their brain to teach … </li></ul><ul><li>Finally , just using their mouth ... </li></ul>
    28. 29.

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