I think we need to be clear what the teaching objectives are for the
learner groups
If we want people to practice EBP then they need to have great E-B
(pre-appraised) resources at their fingertips, plus a raft of other
items - the ready prepared meal approach
If we want people to go that step further, the question that is not
answered by pre-appraised sources, then they need to know how to
search, appraise, etc - the cooks version
the final step is to bring the data together as a consensus e-b guide
to that problem - the chef's level
I am sorry not to be able to dine out in Sicily this year..........
Martin
On 2009-10-21, at 3:16 AM, Paul Glasziou wrote:
> Dear Neal
> Thanks for the comments which we will definitely include in the
> discussions in Sicily. I'm not sure this is so radically different to
> the current Sicily statement which suggested that the steps of
> question
> asking, finding and applying evidence (and decision making) were as
> important as critical appraisal. As Rod suggests though, I would not
> want to see critical appraisal removed altogether. Even if we use
> summaries of evidence, we should check that the summary is based on
> good
> evidence. Otherwise we risk slipping back into authority-based
> medicine
> where we uncritically accept the dictates of a remote committee who
> may
> or may not have looked at the evidence critically, and who are
> certainly
> not sitting in my clinical situtation. So I don't think we should take
> the E out of EBM ;-) I look forward to discussing further in Sicily.
> Paul Glasziou
>
> Maskrey Neal wrote:
>> Hi Paul and Group
>>
>> Sit down before you read this. It's a bit radical, but I have
>> tapped to
>> the group about some of this before so there won't be any surprises.
>> However, despite you knowing this, you might want to take a deep
>> breath
>> before continuing.
>>
>> 1. I'm not criticising. Simply standing on the shoulders of giants.
>> 2. It seems to some of us that the current statement, and indeed
>> the EBM
>> movement, focuses too exclusively on one person finding information
>> when
>> they need it. That's the hardest bit of EBM. Teaching searching and
>> critical appraising is arguably necessary but alone its not
>> sufficient
>> for evidence to be used in practice - especially when busy clinicians
>> have about one hour a week available for "CPD" (and quite right too -
>> skilled clinicians should be seeing patients not critically
>> appraising).
>> They find searching and appraising tough. Then they don't use it.
>> Then
>> they've forgotten how to do it and how good it was to be able to do
>> it.
>> Then they see others abusing it. And become disenchanted.
>> 3. Both the research describing how clinicians make decisions and the
>> research from the cognitive psychologists shows that clinicians are
>> human and make decisions using system 1 whenever possible - the
>> cognitive miser effect. That means brief reading and talking to other
>> people are powerful influencers - alongside personal experience.
>> System
>> 2 processing to get to a decision is hard work, time consuming and
>> needs
>> to be purposeful. People often don't have time in the clinical
>> setting,
>> or don't do it. Or have no idea how they go about making decisions.
>> Yet
>> make loads of decisions. Scary.
>> And they don't do numbers such as absolute and relative risk so can't
>> describe risks and benefits to patients in terms they stand the best
>> chance of understanding.
>> 4. So we need to move beyond the traditional EBM paradigm.
>> 5. This is my current scribble. 3 parts:-
>> a. Information Management
>> Where and how do I find the best summaries of evidence?
>> Hunting - the four steps when stuck
>> Foraging - getting high quality public
>> sector critically appraised alerts re
>> the new research
>> Hot synching - checking out once or
>> twice a year that I'm treating the common
>> conditions according to the best
>> evidence
>> What skills do I need to understand a summary?
>> b. Clinical Decision Making
>> How do we make decisions, in life as well as clinicians?
>>
>> How can I make better decisions, incorporating evidence
>> whenever that's appropriate?
>> c. Shared decision making
>> How can we engage patients in decision making?
>> How can we optimally describe the risks and benefits
>> based on the best available evidence?
>> 6. This fits with my timeline of EBM......tapped to the group
>> previously
>> EBM v 1.0 Conceptual
>> EBM v 2.0 Technical development
>> EBM v 3.0 Industrial (large (ish) scale teaching and
>> guideline production)
>> EBM v 4.0 Customer focussed.
>> 7. I'm worried if we don't get to customer focussed.
>>
>> Really looking forward to Sicily. Hope this helps. It's meant
>> entirely
>> helpfully.
>>
>> Bw
>>
>> Neal
>>
>> Neal Maskrey
>> National Prescribing Centre
>> Liverpool UK
>>
>> Neal
>>
>>
>> -----Original Message-----
>> From: Evidence based health (EBH)
>> [mailto:[log in to unmask]] On Behalf Of Paul
>> Glasziou
>> Sent: 18 October 2009 16:37
>> To: [log in to unmask]
>> Subject: The EBM curriculum - revising the Sicily statement
>>
>> Dear All,
>> Do you have suggestions about the curriculum for EBM? The forthcoming
>> Sicily EBHC conference (28-31 Nov) will include afternoon
>> discussions of
>>
>> the EBM curriculum. The Sicily Statement on the Curriculum for
>> evidence-based practice arose out of the first Sicily meetings.
>> We are planning to revise and extend the statement, and would
>> appreciate
>>
>> suggestions and help.
>> Some questions we have:
>> 1. Do you have any comments on the current statement?
>> (It is free to download at: <http://www.biomedcentral.com/1472-6920/5/1
>> >
>> ).
>> 2. What's missing? The current Sicily statement is a set of
>> objectives
>> structured around the 4 steps of EBM (ask a question; search;
>> appraise;
>> and apply the evidence). Is that sufficient or are there other vital
>> topics?
>> 3. Process and Evaluation. The current Sicily statement says little
>> about 2 other components of curriculum: (i) How do we organise
>> learning? (ii) How well are we achieving our aims?
>> Do you have suggestions regarding these? For example, how should
>> the EBM
>>
>> curriculum be organised across the years of the course?
>> 4. Do you have other suggestions about process, publication,
>> lobbying,
>> etc?
>> 5. Do you have examples of EBM curricula that you can forward to
>> us? Or
>> examples of use of the current Sicily Statement?
>> We will post progress to the EBHC email list after the conference,
>> and
>> would welcome contributions,
>> Best Wishes
>> Paul Glasziou
>>
>>
>
> --
> Paul Glasziou
> Director, Centre for Evidence-Based Medicine,
> Department of Primary Health Care,
> University of Oxford www.cebm.net
> ph - +44-1865-289298 fax +44-1865-289287
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