Hi Ben & Paul,
In Sydney medical school, with a graduate medical course of four years, we
have an approach similar to Oxford.
The majority of the students are 'experts' in stats and appraisal and do
what is expected in the assignments wit high grades especially PEARLS.
However when given a 'real-life' situation (such as in general practice
settings/problems) and the limited time of 'minutes' (not hours), we have
shown that they can still improve with a session in information management
skills (fast focuses searching for quality pre-appraised evidence and rapid
appraisal - the 'NEW SCHOOL OF EBM'). Preliminary studies and have shown how
a two hour hands-on session could improve their confidence and performance
under 'real-life' settings.
I think that a bit more tweaking can be done to convert a good theoretical
knowledge about 'clinical epidemiology' to real-life practice of EBM with
the added bonus of information management skills. I hope this can in some
way be stressed in the revised statement.
Best regards
Kumara
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Paul Glasziou
Sent: Sunday, 25 October 2009 2:32 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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