I may formulate better my proposal:
Stage 1. Framing the patient's problem within current knowledge and the
local, personal, social and cultural context
Stage 2. Setting a goal compatible with the patient's conditions,
preferences and values, and translate uncertainty to an answerable question
This would move a number of issues from stage 4 (application) to the
start of the process. Would give better weight to general
knowledge/expertise. Would recognize complexity. And would put the
patient and his/her process at the center.
I will have a poster in Sicily to support this proposal
As for uncertainty, it is obviously a feature of objective/scientific
knowledge and should be recognized throughout the whole process, but the
more important time point to call attention to it could be at the time
of making a choice (application), after all the efforts to minimize it.
regards
Piersante Sestini
Nina Rydland Olsen wrote:
>
> 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
>
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