Paul,
Is there anyway that the members who cannot attend this meeting can
participate in real-time or in even an asynchronous way
SKYPING (with a simple web cam) during discussion time
Using ADOBE ACROBACT CONNECT to have a ongoing summary (also allows feedback
and questions)
Days summary on the conference web site (may be for a nominal fee) so that
members who are not physically present can know and comment before the next
morning session
Twitter (most conferences are now using this)
(I know all these are can be easy to suggest but hard to do. Cost is the
least problematic. Some of the attending persons will have to do a bit of
additional tasks or employ a few to do this - this is why I suggested a
fee!)
Kumara
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Paul Glasziou
Sent: Friday, 23 October 2009 2:43 AM
To: [log in to unmask]
Subject: Re: The EBM curriculum - revising the Sicily statement
Hi Fred
That's a nice idea. We might develop a list of principles that spell
out the philosophy of EBM first, and then move to the skills.
I'd definitely include being patient-centred among these. Something like
(stealing from Dr Armstrong):
1. Since the aim of EBM is to benefit patients, its practice should be
patient-centred.
2. EBM require comfort in saying we don't know and embracing this as a
positive phenomenon.
3. Though knowledge comes from a variety of sources, EBM favours high
quality research evidence over case experience or theories of mechanism.
4. Others ....
Thanks all,
Paul Glasziou
Tudiver, Fraser G. wrote:
> I also wish to thank Paul for opening this dialogue.
> Rakesh made an important point with regard to the "challenge" to keeping
it patient centered. Even though the concept of patient focus is in the very
definition of EBM, I along with others find that it is often absent, in
particular in the teaching of EBM skills. I suggest that patient-centered
focus not be yet another EBM step, but instead be seen as a
concept/construct that permeates across all the EBM steps.
>
> Regards,
>
> Fred Tudiver
> Director for Primary Care Research
> Director, International Center for Evidence-Based Medicine
> Dept Family Medicine
> James H Quillen College of Medicine
> East Tennessee State University
> Box 70621
> Johnson City, TN, 37614
> Voice: 423-439-6738
>
> ________________________________
>
> From: Evidence based health (EBH) on behalf of Rakesh Biswas
> Sent: Thu 10/22/2009 7:47 AM
> To: [log in to unmask]
> Subject: Re: The EBM curriculum - revising the Sicily statement
>
>
> Very important point Nina.
>
> I have quoted from Dr Armstrong's work before on this list and somehow
feel like revising it from time to time when we approach these areas:
>
> Not knowing, the chaos of real life clinical questions, a healthy
skepticism, appreciation of the rapid turnover of information and the
realization that active and interactive learners learn, are the energies
that fuel problem based learning in EBM. (Armstrong 2004).
>
> This variety of bottom up learning in medicine has spurred caregivers and
care seekers (in effect most humans) into moving from routinely accepting
media dominated content to questioning the vested interests that may control
them.
>
> The biggest challenge for EBM facilitators has been keeping it
patient-centered. It has been noted that residents and medical students
often struggle with a format where the primary focus is the patient and is
question driven and where the emphasis is in large part on process and skill
acquisition rather than finding "the right answer". This takes them out of
their cultural comfort zone of didactic and content focused education where
not knowing is traditionally frowned upon. It requires that they become
comfortable saying they don't know and embrace this as a positive
phenomenon, which will over time, drive their desire to know and keep up to
date in a world of medicine where the only constant is change.(Armstrong
2004).
>
> Thanks Paul for initiating such a good discussion.
>
> regards,
>
> rakesh
>
>
> On Thu, Oct 22, 2009 at 4:35 PM, Nina Rydland Olsen
<[log in to unmask]> wrote:
>
>
> Hello,
>
> I agree that we need another step before "step 1: Translation of
uncertainty to an answerable question".
>
> In Norway, we teach our students that step 1 is to identify your
information need; asking them to reflect on "What do you need more
information about?", What information do you already have about this
clinical issue?", "What is usual practice (today) concerning this issue?". I
guess this is equivalent to "step 0" that you already mention in the Sicily
Statement:
>
> "Indeed, the most difficult step (sometimes dubbed
> "step 0") is to get students and colleagues to recognise and
> admit uncertainties."
>
> Perhaps this step should be step 1?
>
> Best wishes
>
> Nina Rydland Olsen
> PhD student
> Centre of Evidence-Based Practice
> Bergen University College, Norway
>
>
> -----Opprinnelig melding-----
> Fra: Evidence based health (EBH)
[mailto:[log in to unmask]] På vegne av Piersante Sestini
> Sendt: 22. oktober 2009 12:30
> Til: [log in to unmask]
> Emne: Re: The EBM curriculum - revising the Sicily statement
>
>
> Paul Glasziou wrote:
> > 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.
>
> I have two suggestions, both relative to the starting steps:
>
> 1) Add a step on "setting a goal" at the beginning. Without a goal
is
> impossible to ask a question (in particular, to select an outcome)
> Note that this would require to move the exploration of patient's
values
> at this stage, since obviously the patient should participate in
the
> choice of the goal (and hence in framing the question).
>
> 2)Integrate the proposal of Franz Portzolt of explicitly consider
> current knowledge and expertise (and look for more expertise if
needed
> using background questions) while framing the problem.
>
> Porzsolt F, Ohletz A, Thim A, Gardner D, Ruatti H, Meier H,
> Schlotz-Gorton N, Schrott L. Evidence-based decision making--the
6-step
> approach. ACP J Club. 2003 Nov-Dec;139(3):A11-2
>
>
>
> regards,
> Piersante Sestini
>
>
>
--
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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