I agree with Dr. Kaiser on the first point wholeheartedly. Reality stinks.
On the second point, I have tried, with varying degrees of success, to teach
medline searching using the 3 or 4 part question elements as one approach to
define and narrow the search. The individual elements may need to be
broadened or converted to a MeSH heading (this is one of the skills that can
be difficult to teach & learn) then combined with the boolean operators to
successively narrow the search. Though it may not be as sensitive a
strategy as the scripts developed by Haynes and others, it can be specific
and efficient and it preserves the conceptual continuity that Dr. Korsen
mentions. As far as the software interface, that would be great, and to my
mind could be developed. I wonder if the folks at the San Antonio Cochrane
center have looked at this at all.
Ken Yew
LCDR, MC, USN
NH Jacksonville
Department of Family Practice
(904) 777-7963 dsn 942
-----Original Message-----
From: Susan Kaiser, M.D. [mailto:[log in to unmask]]
Sent: Wednesday, December 20, 2000 1:09 PM
To: [log in to unmask]
Subject: Re: FW: Teaching EBM
Dear Dan,
I agree that these are crucial questions. If you can't answer them, it's
hard to pursue and evidence-based approach oneself, much less advocate its
use to others.
>> 1. What ideas do people have about dealing with the frustration
frequently
>> encountered by the realization that for many clinical questions, there
are
>> no evidence-based answers? How do you keep the residents from dismissing
>> the whole concept because they cannot yet always find answers in a prompt
>> manner?
This represents a failure of concept rather than of practice. Real
solid answers are lacking to many or most medical questions no matter what
approach you use, EBP or otherwise. The entire goal of evidence-based
practice is to find, recognize, and use the best available evidence. If
you are all alone in the desert, maybe the best evidence is in your head.
If you are at a major medical center, it's likely to be electronically
available from the library. And the best evidence may not be very good, at
that, but part of EBP is being able to assess how good the evidence is.
Know the quality of the basis for your decisions, and use the best you can
get. That's what EBP teaches you how to do.
Residents might be interested to know how little of what they are
authoritatively taught is based on real evidence. It might be good for
them to know this.
>> 2. (A question and a request) How valuable do people find the process of
>> structuring the clinical question, per Sackett and others? While it makes
>> sense to me to have the residents think about the question they are
asking
>> and focus it, the formal structuring of patient/problem, intervention,
>> comparison, and outcome doesn't always assist in the process of searching
>> for the answer - the search engines do not accept this structure to a
>> query. Thus the request to those of you who are working on the FPIN as
>> well as others - wouldn't it be nice if we had a database that could be
>> searched by structuring and then asking your question in this format, or
>> at least in a way that facilitated the process of moving from the
clinical
>> situation to the information needs in a relatively direct way.
My thought about this, and I'll try to be less long-winded, is that
the primary purpose of the properly formulated question is to define what
you are asking, to enable you to decide whether you have found an answer,
and to help determine what may be missing from what you have found. I
agree completely that the question isn't much help in doing a search, as it
is generally so specific that if you got any hits you'd be very lucky!
I will be very interested in what others have to say.
Regards,
Sue
Susan Kaiser, MD
Department of Surgery, Box 1259
The Mount Sinai School of Medicine
New York, NY 10029
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