 |
 |
Hi Fred That's a nice idea. We might develop a list of principles that spell out the philosophy of EBM first, and then move to the skills. I'd definitely include being patient-centred among these. Something like (stealing from Dr Armstrong): 1. Since the aim of EBM is to benefit patients, its practice should be patient-centred. 2. EBM require comfort in saying we don't know and embracing this as a positive phenomenon. 3. Though knowledge comes from a variety of sources, EBM favours high quality research evidence over case experience or theories of mechanism. 4. Others .... Thanks all, Paul Glasziou Tudiver, Fraser G. wrote: > I also wish to thank Paul for opening this dialogue. > Rakesh made an important point with regard to the "challenge" to keeping it patient centered. Even though the concept of patient focus is in the very definition of EBM, I along with others find that it is often absent, in particular in the teaching of EBM skills. I suggest that patient-centered focus not be yet another EBM step, but instead be seen as a concept/construct that permeates across all the EBM steps. > > Regards, > > Fred Tudiver > Director for Primary Care Research > Director, International Center for Evidence-Based Medicine > Dept Family Medicine > James H Quillen College of Medicine > East Tennessee State University > Box 70621 > Johnson City, TN, 37614 > Voice: 423-439-6738 > > ________________________________ > > From: Evidence based health (EBH) on behalf of Rakesh Biswas > Sent: Thu 10/22/2009 7:47 AM > To: [log in to unmask] > Subject: Re: The EBM curriculum - revising the Sicily statement > > > Very important point Nina. > > I have quoted from Dr Armstrong's work before on this list and somehow feel like revising it from time to time when we approach these areas: > > Not knowing, the chaos of real life clinical questions, a healthy skepticism, appreciation of the rapid turnover of information and the realization that active and interactive learners learn, are the energies that fuel problem based learning in EBM. (Armstrong 2004). > > This variety of bottom up learning in medicine has spurred caregivers and care seekers (in effect most humans) into moving from routinely accepting media dominated content to questioning the vested interests that may control them. > > The biggest challenge for EBM facilitators has been keeping it patient-centered. It has been noted that residents and medical students often struggle with a format where the primary focus is the patient and is question driven and where the emphasis is in large part on process and skill acquisition rather than finding "the right answer". This takes them out of their cultural comfort zone of didactic and content focused education where not knowing is traditionally frowned upon. It requires that they become comfortable saying they don't know and embrace this as a positive phenomenon, which will over time, drive their desire to know and keep up to date in a world of medicine where the only constant is change.(Armstrong 2004). > > Thanks Paul for initiating such a good discussion. > > regards, > > rakesh > > > On Thu, Oct 22, 2009 at 4:35 PM, Nina Rydland Olsen <[log in to unmask]> wrote: > > > Hello, > > I agree that we need another step before "step 1: Translation of uncertainty to an answerable question". > > 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 > > > -- 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