<<We are starting a "new" journal club approach>>
Ati,
We've been doing the question-based journal club for about three months.
We do it twice a month, and, for now, have the same three part format as
detailed in "the little red book." So far it's been well received, but one
major cautionary note: the first few questions chosen (by interns) were
mostly background questions, and in leading them through the focus into a
foreground question, we wound up with prognosis questions that had very
little literature to answer them. Though this is a potentially useful
exercise, it can (and did, a little) discourage people you're trying to
"sell" on the concept of EBM. I've been getting a little more directive in
terms of orienting questions toward topics on which I know there's evidence
so that we can get a firm bottom line at the end of the sessions. And that,
in fact, has been a theme in the sessions so far...what did we learn from
this, and how do we relate it to the patient (thank goodness they're asking
those questions!!!)?
The question is the hardest, but most critical part. One of my colleagues
leading another of the small groups got a little tangled at first because
the question was too much background, and not the good three-parter. That
being said, I'm trying to figure out a way to incorporate a focused
answerable BACKGROUND question (a la Scott Richardson's editorial in the
recent EBM issue) into the journal clubs...after my group gets the concept
as designed, I might try this. We offer one-on-one instruction and
mentoring on searching and appraisal.
Haven't tested this approach, but I'm wondering if a pre- and post-test
will give you any other information other than the fact that they were awake
during the sessions? I've toyed with the idea of teaching a topic to two
small groups using 1) EBM/clinical question techniques and 2) standard
expert based lectures, then presenting a new question/topic and studying how
the groups got the answer to that next question - i.e. did it change the way
they learn and approach questions...Obviously blinding and contamination
become major issues...
Just some thoughts...I'd love to hear other experiences!
John
John Epling, MD
LCDR, MC, USNR
Family Practice Residency Program
US Naval Hospital
2080 Child St.
Jacksonville, FL 32214
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> -----Original Message-----
> From: [log in to unmask]
> [mailto:[log in to unmask]]On Behalf Of Ati
> Yates
> Sent: Thursday, September 17, 1998 6:48 PM
> To: [log in to unmask]
> Cc: [log in to unmask]; [log in to unmask]
> Subject: Re: EBH assignment
>
>
> Hello Paul, Nancy, list members,
>
> in our internal medicine
> residency curriculum which is based on priniciples described in Professor
> Sacket et al 's little EBM book (starting around page 190) and seems to
> have had quite some history and success at McMasters University and
> several sites in the UK, probably other locales as well.
> The key principle, to my mind, when working with people who are either
> clinicians or otherwise responsible for decisionmaking in health
> care is to
> start with the questions people have about what they are doing. That
> centers the learning right at the crux of the learner's need and desire to
> learn. The rest of the process should follow in the same vein. Offering
> help to people who need to answer questions should help the learning
> process as well as the motivation in the learner. Next seems necessary
> to have resources ready to help the process:
>
> 1. A clear approach to choosing questions that are most likely to lead to
> answers using EBM strategies, and that are relevant and important
> enough to
> spend time and energy on (the latter esp. for group work--an individual
> patient in my care may elicit a question that is important enough for its
> own sake because the patient needs it answered.)
> 2. A clear approach to formulating the question so as to lead to a
> successful search
> 3. Help in searching in an organized, hierarchial fashion, making use of
> critically appraised articles on common problems already collected by a
> growing number of centers, and a strategy for searching if
> nothing is found
> in these sources.
> 4. Help in selecting among found articles for the best evidence for the
> problem at hand.
> 4. A clear structured approach to critical appraisal with attention to
> both validity and clinical importance.
> 5. Help on applying the evidence thus found to the patient at hand.
>
> I plan to do almost all of this within the monthly group sessions, except
> the searching. Librarians at our hospital library have been delighted to
> be asked to help and we plan to set up tutorials for the person doing the
> search. I am planning to let the group decide when they need a structured
> lecture on things like EBM numbers or searching clinics. We might put
> these in the same time slot in between the regular journal club meetings.
>
> Another journal club working with this basic priniciple is underway in
> Scottsdale Arizona at the Mayo Thunderbird Clinic, organized by Scott
> Endsley. Are there any other on the list these days who are running or
> participating in patient question based (EBM) Journal Clubs? It would be
> great to compare notes and hear of your experiences.
>
> By the way, has anyone tested the process with a pre and post test/survey?
> I would appreciate hearing of that experience also.
>
> Best regards,
>
> Ati Yates
>
>
>
>
>
> At 04:42 PM 9/16/98 -0400, you wrote:
> >I have recently introduced EBM and critical analysis into an OB
> >clerkship for third year medical students
> >I adapted a program published by David Grimes Obstet Gynecol 1995,
> >86;45-457
> >I utilize three lectures: EBM in OB, critical analysis and statistics
> >for the uninterested
> >i have two journal club analyzing 4 articles on the IUD and PID (all
> >loaded with type I and II error) and do a small group session with an
> >evidenced based case study
> >Also have required reading: Reading the Medical Literature published by
> >ACOG (it may be available on their website)
> >do not yet have objective data on effectiveness
> >You must get the rest of your faculty at least knowledgeable if not
> >enthusiastic first
> >good luck!!
> >
> >Nancy Sowan wrote:
> >
> >> I am introducing evidence-based-practice to the graduate
> >> students in our program at the University of Vermont School
> >> of Nursing. I would be interested in any suggestions for
> >> learning activities for novices in this area.
> >>
> >> Thank you in advance,
> >>
> >> Nancy Sowan, RN, PhD
> >> University of Vermont
> >> School of Nursing
> >
>
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