I echo what Sally has to say
I am currently doing some research surrounding the implementation of EBP
for OTs. The use of clinical reasoning and being able to put findings
from research into practice is very important in their views. This is
not something which always comes easily and the teaching should not just
be during training but an ongoing opportunity to discuss these areas.
Factors such as the organisation - the support it gives and the culture
of the organisation are all important and should be understood as well
as the technical skills.
Ruth Duffy
[log in to unmask]
NHS West Midlands
Workforce Deanery
St. Chad's Court
213 Hagley Rd
Edgbaston
Birmingham
B16 9RG
0121 695 2307
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Sally Bennett
Sent: 27 October 2009 12:21
To: [log in to unmask]
Subject: Re: The EBM curriculum - revising the Sicily statement
Hi all,
I apologise if I'm duplicating what has already been discussed- I
haven't finished reading all the emails that have come through on this
topic.
I contribute to teaching EBP to allied health at The University of Qld,
Australia.
In addition to the type of content that has been discussed in this list,
we have found it useful to include specific content on discussing
research evidence with patients and expect students to role-play how
they might explain evidence related to specific clinical scenarios and
articles that students have already appraised. This leads onto lots of
fascinating discussions about information preferences and so on.
The other content that may be relevant to teaching EBP is clinical
reasoning. This could be used to help students consider how one goes
about integrating different pieces of the puzzle-(research evidence,
clinical experience and patient values).
Regards
Sally
Sally Bennett
Lecturer
Division of Occupational Therapy
The University of Queensland
St Lucia
QLD 4072
Australia
Email: [log in to unmask]
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Paul Glasziou
Sent: Sunday, 25 October 2009 1:32 AM
To: [log in to unmask]
Subject: Re: The EBM curriculum - revising the Sicily statement
Hi Ben,
Yes - I think the order of teaching things is important, and we shall
certainly look at this (I know Julie Tilson has been working on this
issue).
From failed experience, we also think that some basics should be taught
first (searching, statistics, appraisal, etc) before putting it all
together. In Oxford the basics happen in the pre-clinical years, and by
the clinical years they are able to apply this. So early in year 4 we
give them a similar excerise to your question, and nearly 100% come back
(within a 24-hour turnaround) with good searches, appraisals, and
applications. So I am curious about what your students had done
previously, and what stage of background knowledge they have? (And I
urge you not to give up yet ;-)
Cheers
Paul
Djulbegovic, Benjamin wrote:
> Here is a small uncontrolled observation that may further inform your
deliberations. Every time I am on clinical service, I tell students,
residents or fellows the following: I have one educational task for each
of you. Your job is to identify the issue/question/problem in YOUR
patient that you do NOT know the answer to. I want you then to go in the
literature and search for the answer (evidence) and report back to the
team.
> I have been doing for many years. Do you know how many trainees have
done this properly (according to the EBM paradigm)? Zero! (and many of
them would refer to the authority in providing their answer since there
are some famous people around they can easily ask for the answer). (In
the past, when we had more time to teach at bedside, this actually
provided the great opportunity for teaching. Not so any more, since the
entire patient care and teaching are increasingly compressed in time)
> In my mulling over this, I came to conclusion is that it is the
content i.e. background knowledge that matters. People without
sufficient background knowledge have difficulties articulating the
questions (it has been said that capability to articulate question is
one of definition of creativity). This implies that we should teach EBM
in the later years of training and not in early years (as it is
currently the case, at least in my instutition , but also at several
other institutions I know). Perhaps the revised Sicily Statement should
take this into account.
> wishing you the most productive conference
> best
> ben
> ps I am so curious to see what will come out of the discussion
regarding the need to teach principles of interpretation of medical
evidence (critical appraisal) vs. decision-making. The former has been
sufficiently well operationalized, but does current state of knowledge
allows operationalization of decision-making process? So far, for the
most part, teaching EBM has been prescriptive ("how to do" stuff, with
the focus on E aspects of EBM). Can we be really prescriptive when it
comes to decision-making at this point of time? Looking forward to
learning the outcomes of the Sicily meeting discussion with a great
interest.
>
> ________________________________________
> From: Evidence based health (EBH)
[[log in to unmask]] On Behalf Of Piersante Sestini
[[log in to unmask]]
> Sent: Saturday, October 24, 2009 7:46 AM
> To: [log in to unmask]
> Subject: Re: The EBM curriculum - revising the Sicily statement
>
> My understanding is that background knowledge shouldn't be used to
make
> practical decisions, but is essential to frame problems and to build
> foreground questions.
> I agree that guidelines can be used to address both kind of questions.
>
> Piersante Sestini
>
> R. Kok wrote:
>
>> My experience in teaching colleagues EBM is that answers to
background questions can be very usefull in making practical decisions,
especially in learners. However even with back ground questions
aggregated evidence, for example guidelines can be very instrumental.
>>
>> Regards,
>> Rob kok
>>
>> ----- Original Message -----
>> From: Piersante Sestini <[log in to unmask]>
>> Date: Saturday, October 24, 2009 10:17 am
>> Subject: Re: The EBM curriculum - revising the Sicily statement
>> To: [log in to unmask]
>>
>>
>>
>>> I agree with your practical points. But just because they are
>>> learners,
>>> they have more background questions that foreground ones.
>>> So first of all they need to learn how to deal with the need for
>>> general
>>> knowledge (that is, background questions), rather than than to dig
>>> just
>>> into foreground questions from the start, as may be could be
suitable
>>>
>>> for old hands.
>>>
>>> regards,
>>> Piersante Sestini
>>>
>>>
>>> Martin Dawes, Dr. wrote:
>>>
>>>
>>>> I think we need to be clear what the teaching objectives are for
the
>>>>
>>>>
>>>
>>>> learner groups
>>>>
>>>> If we want people to practice EBP then they need to have great E-B
>>>>
>>>> (pre-appraised) resources at their fingertips, plus a raft of other
>>>>
>>>> items - the ready prepared meal approach
>>>>
>>>>
>>>>
>>
--
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
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