I would add that individual practitioners likely function at different levels of
a user/doer/replicator hierarchy depending on the area of clinical
decision-making i.e. I may be content to be a replicator in areas in which I
have little background expertise but perform more regularly in the user mode
for diseases/questions I encounter frequently and take the energy/interest to
search the primary liteature on....
Vinod H. Srihari, M.D.
Assistant Professor
Department of Psychiatry
Yale University School of Medicine
Director, STEP
Specialized Treatment Early in Psychosis
Staff Psychiatrist
Connecticut Mental Health Center (CMHC)
34 Park Street
New Haven, CT 06519
Office: (203) 974-7816
Fax: (203) 974-7502
Quoting Hutchinson Andy <[log in to unmask]>:
> >> But it might be better to think of this as a spectrum. For example, some
> folk distinguish EBM "users" from "practioners" based on whether they
> are appraising themselves or trusting others to do the appraisals
>
> I would agree with that whole-heartedly.
>
> So may I suggest we have at least five different levels, with the following
> ideas of demonstrable competencies:
>
> 1 - entry level - eg can describe the 5S approach to finding answers to
> clinical questions (or similar); can describe the hierarchy of evidence and
> why it is as it is; understands the difference between absolute and relative
> risk and how baseline risk affects absolute benefits; can explain in simple
> terms the common terms use in EBM (eg RR, RRR, ARR, NNT, NNH, P, 95%CI)
>
> 2 - developing practitioner - eg as 1 but also: shows evidence of using the
> 5S approach (or similar) much of the time in his/her practice with a foraging
> approach to keeping up to date with relevant, valid information (Slawson and
> Shaunesey); developing ability to communicate the evidence base to patients
> in ways meaningful to them
>
> 3 - higher level practitioner - as 1 and 2, but also: practice is
> characterized by a hunting and foraging technique; audits own (or team's if
> appropriate) practice against best available evidence; well developed ability
> to communicate the evidence base to patients in ways meaningful to them;
> encourages and supports others to develop as EBM practitioners; developing
> critical appraisal skills
>
> 4 - Advanced practitioner - as 1,2,3 but also: well developed critical
> appraisal skills used locally to help develop local practice guidelines
> and/or interpret evidence for other practitioners; mentor to level 1,2 and 3
> practitioners; researches improved ways of communicating evidence to patients
> (eg patient decision aids, etc)
>
> 5 - Master level - as 1,2,3,4 but also: expertise is recognised at
> national/international level; leads or contributes to major pieces of EBM
> work of wider significance (eg published systematic reviews and
> meta-analyses); researches across the EBM spectrum
>
>
> OK, I'm sure this could be improved a great deal, and the competencies here
> could be moved around, added to and deleted.
>
> But I do strongly feel that a stepped approach is important. The danger
> otherwise is that people think they need to be at level 4 or 5 to be an EBM
> practitioner, and move there straight away - and feel disheartened and give
> up. It may be that level 3 or 4 is right for them, but as Paul says below,
> it's a gradual shift in clinical practice over years - and if we could get
> most people to level 2 (or even level 1!) we'd do a lot for modern patient
> care.
>
> I'd be most interested in and grateful for any comments people have
>
> Andy
>
>
> Andy Hutchinson
> email: [log in to unmask]
> tel: 07824 604962
> web: www.npc.co.uk or www.npci.org.uk
>
> -----Original Message-----
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of Paul Glasziou
> Sent: 02 April 2008 18:18
> To: [log in to unmask]
> Subject: Re: how can I show I am an evidence based practitioner
>
> Dear Bruce
> An excellent question! I think your list is a good start, but I'd add
> appraising primary research, reading a secondary abstract journal, and
> running a team "journal" club to the list.
> But it might be better to think of this as a spectrum. For example, some
> folk distinguish EBM "users" from "practioners" based on whether they
> are appraising themselves or trusing others to do the appraisals (see:
> Akl EA, Maroun N, Neagoe G, Guyatt G, Schünemann HJ. EBM user and
> practitioner models for graduate medical education: what do residents
> prefer? Med Teach. 2006 Mar;28(2):192-4. )
> I also tell folk that the difference is not an instant change, but being
> EBM-aware leads to a gradual shift in clinical practice over years, as
> we adopt or drop different treatments, tests, etc.
> Cheers
> Paul Glasziou
>
>
>
> Bruce Arroll wrote:
> > Dear all
> >
> >
> > I would like your thoughts on this question?
> > I have recently run seminars with nurses and GPs on EBH. I start with
> > the question "how would you know I am an evidence based practitioner". I
> > am aware that there is interest in this from the research point of view
> > but I am keen to build up a list of "activities" that would show I
> > practice in an explicitly evidenced based manner.
> >
> >
> > You would almost certainly have to see me in my clinical setting and
> > interview me about my practice
> >
> > 1. Have ready access to evidence based guidelines from say NICE, SIGN,
> > New Zealand guidelines group
> > -when a new guideline is published I would look at the algorithm
> > and see if my practice was concordant and if not I would investigate the
> > references further and change my behaviour
> >
> > 2. I would conduct audits on my practice and alter practice accordingly
> >
> > 3. I would use evidence based knowledge refineries eg Cochrane pearls
> > from www.cochraneprimarycare.org, perhaps medscape, BMJplus
> >
> > 4. Know the hierarchy of evidence and acknowledge that in my discussions
> > with patients (eg where there was rct evidence I would say there is good
> > trial evidence about this or where there is only case series I would
> > couch the evidence in terms of there is not a lot of good evidence about
> > this. i.e I would explicitly use the language of EBH
> >
> > 5. I would use explicit evidence based clinical textbooks such as
> > dynamic medical.com or some of the others but hunt for evidence eg in
> > uptodate in their abstracts
> >
> > Regards
> >
> > Bruce
> >
> > Bruce Arroll MBChB, PhD, FRNZCGP, FAFPHM
> > Professor and Head of Department
> > Dept of General Practice and Primary Health Care
> > University of Auckland
> > Private Bag 92019
> > Auckland
> > ph 649-3737599 ext 86978
> > fax 649-3737624
> >
> > Physical address room 378 building 730
> > School of Population Health
> > Corner of Morrins and Merton Rds
> > Glen Innes
> > Auckland
> > -----Original Message-----
> >
>
>
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