>> 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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