Thank you. Although not related to my original question, I really
appreciate the spirit of Dr. Gutherie's comments. One of the answers to my
question was 45,000 people taught per year. In the spirit of the "NNTeach"
this intervention is likely not harmful, but it does consume a great deal of
resources.
Dr. Gutherie wrote:
>And if the evidence only supports a B (or a C) grade >recommendation to
teach critical appraisal, how come we >promote it with all the vigour of an
A+?
To me that is the key question! I also am participating in and putting on
workshops and up to my eyeballs trying to teach this to 40 residents, but I
want evidence about what works, what doesn't and what works better. As one
planning to attend the "Teaching Effectiveness" conference in Italy this
September, your question and the research studies to answer it are, in my
mind, the most important thing for us to consider.
Ken
NH Jacksonville
Department of Family Practice
(904) 777-7963 dsn 942
-----Original Message-----
From: Guthrie, Dr Bruce [mailto:[log in to unmask]]
Sent: Friday, June 01, 2001 7:04 AM
To: [log in to unmask]
Subject: Re: question on number of people taught EBM
Alan O'Rourke wrote
> ... which makes me think has anyone calculated NNTe (= number
> needed to teach) to prevent an adverse events?
>
> E.G. NNTe for critical appraisal, or any other of the basic skills
> of EBP
It depends what you mean by an 'adverse event prevented'.
There doesn't appear to be any good evidence that teaching critical
appraisal or EBM affects patient outcomes, so you couldn't construct an NNT.
You might be able to construct one for an increase in knowledge or skills,
or change in attitude to EBM, but are these really what matter? See the
systematic review on the effect of treating critical appraisal at
http://www.bham.ac.uk/arif/SysRevs/TeachCritApp.PDF
I've been a bit surprised that this SR hasn't generated any discussion on
the list. If 'teaching EBM' was a new drug, what would our EBM trained
assessment say about spending lots of time and money promoting it? And if
the evidence only supports a B (or a C) grade recommendation to teach
critical appraisal, how come we promote it with all the vigour of an A+? Do
we need RCT/strong experimental evidence of benefit on patient outcomes? I
speak as someone who runs an EBM course, and often wonders what difference
it makes to patients.
The systematic review's conclusion is a challenge:
"This review provides reassurance to those who have invested in critical
appraisal teaching activities that they are likely to have a positive
impact. The evidence is not, however, sufficient to encourage further
expansion of critical appraisal activities, due to limitations on its
validity and significance in practice, and the total absence of results for
important outcomes.
Further studies should be undertaken in partnership between adult
educationalists and healthcare researchers to ensure studies are properly
designed and valid outcomes are used. It is of importance to assess the size
of benefit of critical appraisal training to postgraduates/CPD, as this is
where greatest investment is made. Such an evaluation should be large,
randomised and assess outcomes and changes which are of significance in
practice."
Any takers (or is anyone doing one already)?
Bruce
Bruce Guthrie,
MRC Training Fellow in Health Services Research,
Department of General Practice,
University of Edinburgh,
20 West Richmond Street,
Edinburgh EH8 9DX
Tel 0131 650 9237
e-mail [log in to unmask]
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