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<<Finally a question to the members. The students wanted to know when should they look for evidence? Is it for all cases they will see in their practice and are there any guidelines to decide on which of the cases/patients they should hunt for evidence? Any thoughts on the above will be gratefully received and I will relay them to our students.>> Warning, this answer is tangential (at best) to your question, but you triggered something... A while back, someone (I can't remember who) posted a note on the list to say that they were only able to produce a few critically appraised topics per month (and seemed to feel somewhat guilty about it.) At our program, too, we had the lofty goal that with three-group journal clubs meeting every two weeks and with faculty support for looking at the evidence during precepting sessions, and even with my own personal goal of one CAT per week......the formal production of reviewed evidence just doesn't get done to meet our expectations... HOWEVER, the use of evidence-based resources and "informal CATs" (i.e. ones that aren't saved for posterity in written form) HAS increased markedly...and I think it's here that one of the major battles is won. As you've seen, though, as residents and students begin to question what they've been taught (or face questioning from others - faculty, other residents) they begin to feel as though every clinical encounter will end up in a morass of questions that will tie them to Pub-Med in a never-ending literature search.... I believe (not my original thoughts at all) that EBM (EBP, EBHC) is mostly an evolutionary process. Refining our current knowledge toward more of an evidence-base will take time. So I've adopted (and encourage) a multifaceted approach to the acquisition of this "new" knowledge...do a little journal club activity, supplement it with a little evidence-based journal (EBM, ACPJC) browsing, do a CAT or two per (week/month, whatever), and do the "quick hunt for evidence" (Cochrane, Best evidence, etc.) whenever a patient's problem is bothering you or represents a common situation you'll encounter again... so, to your students, i would say relax and have fun with this rather exciting, empowering, "new" approach to medical education...don't worry about doing it all now... sorry for the length, john John Epling, MD Naval Hospital Jacksonville, FL Family Practice Residency Program %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%