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EVIDENCE-BASED-HEALTH  October 2009

EVIDENCE-BASED-HEALTH October 2009

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Subject:

Re: The EBM curriculum - revising the Sicily statement

From:

Michael Power <[log in to unmask]>

Reply-To:

Michael Power <[log in to unmask]>

Date:

Wed, 21 Oct 2009 09:07:54 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (158 lines)

Hi Neal

I agree with all your suggestions.

This is what I sent Paul directly yesterday (and should have sent to the list - sorry!:

"Here are an outsider's views on what else should be included in the EBP curriculum

1.	The values of EBP that distinguish science-based healthcare from science-free therapies
		More details if you are interested

2.	What the cognitive sciences have to tell us about how we make decisions
		Making decisions includes decisions about diagnosis, and about treatment

3.	How values should be integrated into the decision-making process
		Refs: Bill Fulford's publications

4. Placebo effect

          What is it? (I would argue that the placebo effect should be distinguished from non-specific effects which include placebo effects and measurement bias effects)

          What causes it?

          How is it measured?

          Is it clinically important? Should clinicians exploit it?

          How do we interpret results from trial designs that bundle specific and non-specific effects?"

I also agree with the need to include information about real-life strategies for finding information: when to rely on pre-digested knowledge and when to look for primary sources; and the need for an always-on baloney detector with a dial that shows level of scepticism, not level of belief.

Michael


-----Original Message-----
From: Maskrey Neal [mailto:[log in to unmask]] 
Sent: 20 October 2009 17:05
Subject: Re: The EBM curriculum - revising the Sicily statement

Hi Paul and Group

Sit down before you read this. It's a bit radical, but I have tapped to
the group about some of this before so there won't be any surprises.
However, despite you knowing this, you might want to take a deep breath
before continuing. 

1. I'm not criticising. Simply standing on the shoulders of giants.
2. It seems to some of us that the current statement, and indeed the EBM
movement, focuses too exclusively on one person finding information when
they need it. That's the hardest bit of EBM. Teaching searching and
critical appraising is arguably necessary but alone its not sufficient
for evidence to be used in practice - especially when busy clinicians
have about one hour a week available for "CPD" (and quite right too -
skilled clinicians should be seeing patients not critically appraising).
They find searching and appraising tough. Then they don't use it. Then
they've forgotten how to do it and how good it was to be able to do it.
Then they see others abusing it. And become disenchanted.
3. Both the research describing how clinicians make decisions and the
research from the cognitive psychologists shows that clinicians are
human and make decisions using system 1 whenever possible - the
cognitive miser effect. That means brief reading and talking to other
people are powerful influencers - alongside personal experience. System
2 processing to get to a decision is hard work, time consuming and needs
to be purposeful. People often don't have time in the clinical setting,
or don't do it. Or have no idea how they go about making decisions. Yet
make loads of decisions. Scary. 
And they don't do numbers such as absolute and relative risk so can't
describe risks and benefits to patients in terms they stand the best
chance of understanding. 
4. So we need to move beyond the traditional EBM paradigm.
5. This is my current scribble. 3 parts:-
	a. Information Management 
		Where and how do I find the best summaries of evidence? 
				Hunting - the four steps when stuck
				Foraging - getting high quality public
sector 					critically appraised alerts re
the new research
				Hot synching - checking out once or
twice a year 				that I'm treating the common
conditions according to 				the best
evidence
		What skills do I need to understand a summary? 
	b. Clinical Decision Making 
		How do we make decisions, in life as well as clinicians?

		How can I make better decisions, incorporating evidence
whenever 		that's appropriate? 
	c. Shared decision making 
		How can we engage patients in decision making? 
		How can we optimally describe the risks and benefits
based on 		the best available evidence?
6. This fits with my timeline of EBM......tapped to the group previously
		EBM v 1.0 Conceptual
		EBM v 2.0 Technical development
		EBM v 3.0 Industrial (large (ish) scale teaching and
guideline 					production)
		EBM v 4.0 Customer focussed. 
7. I'm worried if we don't get to customer focussed. 

Really looking forward to Sicily. Hope this helps. It's meant entirely
helpfully. 

Bw

Neal 

Neal Maskrey
National Prescribing Centre
Liverpool UK

Neal 


-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Paul Glasziou
Sent: 18 October 2009 16:37
To: [log in to unmask]
Subject: The EBM curriculum - revising the Sicily statement

Dear All,
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.
We are planning to revise and extend the statement, and would appreciate

suggestions and help.
Some questions we have:
1. Do you have any comments on the current statement?
(It is free to download at: <http://www.biomedcentral.com/1472-6920/5/1>
).
2. What's missing? The current Sicily statement is a set of objectives 
structured around the 4 steps of EBM (ask a question; search; appraise; 
and apply the evidence). Is that sufficient or are there other vital
topics?
3. Process and Evaluation. The current Sicily statement says little 
about 2 other components of curriculum: (i)  How do we organise 
learning? (ii) How well are we achieving our aims?
Do you have suggestions regarding these? For example, how should the EBM

curriculum be organised across the years of the course?
4. Do you have other suggestions about process, publication, lobbying,
etc?
5. Do you have examples of EBM curricula that you can forward to us? Or 
examples of use of the current Sicily Statement?
We will post progress to the EBHC email list after the conference, and 
would welcome contributions,
Best Wishes
Paul Glasziou

-- 
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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