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Neal - you raise some important and relevant issues but for me your comments also highlight the need for us to be more explicit about the different phases of a comprehensive EBM curriculum. To take an analogy from, say pathophysiology, students initially get taught the basic principles and then they get taught the application of these principles. Your suggestions are mainly about the application phase of a curriculum and I would suggest that the searching for individual papers and critically appraising individual papers should be done as part of the initial principles stage of an EBM curriculum. If you want a radical proposal, I would proprose that no medical student should be able to qualify without first being a significant contributor at all phases of a systematic review, as SRs should be our primary source of evidence when available. We would also generate a lot more SRs in the process! regards Rod On 21/10/2009, at 5:05, "Maskrey Neal" <[log in to unmask]> wrote: > Hi Paul and Group > > Sit down before you read this. It's a bit radical, but I have tapped > to > the group about some of this before so there won't be any surprises. > However, despite you knowing this, you might want to take a deep > breath > before continuing. > > 1. I'm not criticising. Simply standing on the shoulders of giants. > 2. It seems to some of us that the current statement, and indeed the > EBM > movement, focuses too exclusively on one person finding information > when > they need it. That's the hardest bit of EBM. Teaching searching and > critical appraising is arguably necessary but alone its not sufficient > for evidence to be used in practice - especially when busy clinicians > have about one hour a week available for "CPD" (and quite right too - > skilled clinicians should be seeing patients not critically > appraising). > They find searching and appraising tough. Then they don't use it. Then > they've forgotten how to do it and how good it was to be able to do > it. > Then they see others abusing it. And become disenchanted. > 3. Both the research describing how clinicians make decisions and the > research from the cognitive psychologists shows that clinicians are > human and make decisions using system 1 whenever possible - the > cognitive miser effect. That means brief reading and talking to other > people are powerful influencers - alongside personal experience. > System > 2 processing to get to a decision is hard work, time consuming and > needs > to be purposeful. People often don't have time in the clinical > setting, > or don't do it. Or have no idea how they go about making decisions. > Yet > make loads of decisions. Scary. > And they don't do numbers such as absolute and relative risk so can't > describe risks and benefits to patients in terms they stand the best > chance of understanding. > 4. So we need to move beyond the traditional EBM paradigm. > 5. This is my current scribble. 3 parts:- > a. Information Management > Where and how do I find the best summaries of > evidence? > Hunting - the four steps when stuck > Foraging - getting high quality public > sector critically appraised alerts re > the new research > Hot synching - checking out once or > twice a year that I'm treating the common > conditions according to the best > evidence > What skills do I need to understand a summary? > b. Clinical Decision Making > How do we make decisions, in life as well as > clinicians? > > How can I make better decisions, incorporating > evidence > whenever that's appropriate? > c. Shared decision making > How can we engage patients in decision making? > How can we optimally describe the risks and benefits > based on the best available evidence? > 6. This fits with my timeline of EBM......tapped to the group > previously > EBM v 1.0 Conceptual > EBM v 2.0 Technical development > EBM v 3.0 Industrial (large (ish) scale teaching and > guideline production) > EBM v 4.0 Customer focussed. > 7. I'm worried if we don't get to customer focussed. > > Really looking forward to Sicily. Hope this helps. It's meant entirely > helpfully. > > Bw > > Neal > > Neal Maskrey > National Prescribing Centre > Liverpool UK > > Neal > > > -----Original Message----- > From: Evidence based health (EBH) > [mailto:[log in to unmask]] On Behalf Of Paul > Glasziou > Sent: 18 October 2009 16:37 > To: [log in to unmask] > Subject: The EBM curriculum - revising the Sicily statement > > Dear All, > 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. > We are planning to revise and extend the statement, and would > appreciate > > suggestions and help. > Some questions we have: > 1. Do you have any comments on the current statement? > (It is free to download at: <http://www.biomedcentral.com/1472-6920/5/1 > > > ). > 2. What's missing? The current Sicily statement is a set of objectives > structured around the 4 steps of EBM (ask a question; search; > appraise; > and apply the evidence). Is that sufficient or are there other vital > topics? > 3. Process and Evaluation. The current Sicily statement says little > about 2 other components of curriculum: (i) How do we organise > learning? (ii) How well are we achieving our aims? > Do you have suggestions regarding these? For example, how should the > EBM > > curriculum be organised across the years of the course? > 4. Do you have other suggestions about process, publication, lobbying, > etc? > 5. Do you have examples of EBM curricula that you can forward to us? > Or > examples of use of the current Sicily Statement? > We will post progress to the EBHC email list after the conference, and > would welcome contributions, > Best Wishes > Paul Glasziou > > -- > 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