Hello Paul, Nancy, list members,

We are starting a "new"  journal club approach 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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