This document outlines an evidence-based medicine workshop held at Prince Sultan Military Medical City. It discusses the 5 steps of evidence-based medicine (EBM), including asking answerable clinical questions. Background and foreground questions are described, with foreground questions using the PICO framework. The importance of formulating answerable clinical questions is explained. Three clinical cases are presented, with answerable questions provided for each case.
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10th EBM Workshop Questions
1. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Asking AnswerAble
CliniCAl Question
Dr. Faisal Al HaddadDr. Faisal Al Haddad
Consultant of Family Medicine & Occupational HealthConsultant of Family Medicine & Occupational Health
Incharge of Occupational Health in PSMMCIncharge of Occupational Health in PSMMC
2. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
The Five steps (5A) of EBM
• Asking an answerable question
• Acquiring the “best” evidence
• Appraising the evidence
• Applying the acquired and critically appraised evidence to your pt.
• Assessing your performance and hoping to do better next time!
3. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Where and how clinical
questions arise?
• Most common setting is patients’ care setting
• They are mostly about issues related to:
Etiology
Diagnosis
Prognosis
Therapy
Prevention
4. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Types of questions
Background (general knowledge):
Question root: who, what, where, when…etc
An aspect of the disorder
Example: what causes lower limb swelling?
Foreground questions
Ask for a specific aspect of the patient’s illness
Example: what is the accuracy of V/Q scan in this patient with lung
infiltrate on chest-x rays compared to pulmonary arteriogram
6. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Foreground questions
Four components: PICO
• Patient/Population
• Intervention
• Comparison
• Outcome
Example: In patients with incidentally discovered atrial
fibrillation, does anticoagulation compared to no intervention
Improve the long-term mortality and morbidity?
7. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Reactions to knowledge deficit
A clinical question arises
You know the answer
Cognitive Resonance
You do not know the answer
Cognitive Dissonance
Adaptive Response Maladaptive Response
8. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Why bother to formulate
answerable questions?
• They help focusing our scarce time on evidence:
- That is directly relevant to our patients’ needs
- That addresses particular knowledge needs
• Help following a highly productive search strategy
• May suggest the forms that useful answers may take
9. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Why bother to formulate
answerable questions?
• Can help us communicating clearly with other colleagues
• Help make teaching understandable
• Help improving our learning process
10. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Problems in formulating an
answerable questions
• Inability to clearly define the problem
• Inability to articulate the question
• Many questions, scarce time
11. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Factors deciding priority
questions
• Which question is most important to the patient’s well-being?
• Which question is most relevant to the learner’s need?
• Which question is most feasible to answer?
• Which question is most interesting?
• Which question is most frequent in our practice?
13. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
What is an Educational Prescription?
• It specifies the clinical problem that generated the question.
• It states the question, in all of its key elements.
• It specifies who is responsible for answering it.
• It reminds everyone of the deadline for answering it (taking into
account the urgency of the clinical problem that generated it).
• Finally, it reminds everyone of the steps of searching, critically
appraising and relating the answer back to the patient
14. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Case # 1
• 75-year-old man known case of DM since 30 yrs
admitted with shortness of breath, fever, and cough,
and right lower limb swelling for 1 wk.
• On Physical Examination:
T=38.5, pulse=110 min regular, O2 Sat 88%
Chest: bilateral crackles on the bases
Chest x-rays: bilateral lower lobe infiltrates
Right lower limb swelling
15. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Answer #1
In patients suspected to have PE and have CXR
changes, what is the diagnostic accuracy of V/Q scan
compared to pulmonary angiography in diagnosing
PE?
16. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Case #2
• You saw a 70-year-old man for palpitations with no other
complaint
• Physical Examination Findings:
o pulse is 88/min irregular
o Rest of exam: unremarkable
o ECG: atrial fibrillation with a rate of 90/min
o Echo: normal valves and Ejection fraction
17. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Answer # 2
In elderly patients with lone AF what is the benefits of
long-term anticoagulation compared to no
anticoagulation in decreasing the risk of embolic
stroke?
18. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Case # 3
• You have seen a 40-year-old man for general check-up
• Has no complaint
• Physical examination: unremarkable
• Labs: all normal except FBS of 118 mg/dl
19. 10th
Evidence based
medicine workshop
Prince Sultan Military Medical City
Department of post Graduate Medical education
EBM committee
Answer # 3
In middle aged men with impaired FBS, does life style
modification compared to no intervention decrease
the risk of development of DM?