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Example 1
Scenario: Focusing a clinical question to teach Practice-based Learning and Improvement on the in-patient service.
You are an associate residency director in a busy Psychiatry residency program and are in charge of teaching residents on the inpatient service. A lecture was given on the topic of “formulating testable questions.” As a follow-up, you want to reinforce this skill in a patient care setting through discussions of newly-admitted patients.
The illustration below describes how you can address this and other Practice-Based Learning and Improvement learning objectives on the inpatient service. The objectives are that residents will be able to: (a) focus a clinical question, and (b) search the literature and locate evidence that addresses the question.
Illustration:
Identifying a focused clinical question is the first step in evidence-based medicine. Using the systematic approach developed by Sackett, et al., you provide the admitting resident with a worksheet outlining the “Patient, Intervention, Comparison, and Outcome” model for building an answerable question. You guide the resident through the list by asking:
“P” How would you describe a group of patients similar to this patient?
“I” Which main intervention, prognostic factor, or exposure are you considering?
“C” What is the main alternative to compare with the intervention? (if appropriate)
“O” What can you hope to accomplish, measure, improve, effect?
After a few attempts, the resident team arrives at the following question. “In a 15 year-old girl with depression and one episode of suicidal ideation, does admission to an adolescent inpatient unit decrease the incidence of another suicide attempt?” Then using a database such as (InfoRetrieverR) on one of the resident’s pocket PC, you search for new clinical information that may apply to this patient. You find that there are no definitive studies addressing this question. The team discusses the question and decides to expand the search to address all adolescents and all types of treatments. By broadening the search, the team found 21 controlled studies examining issues pertaining to “adolescent,” “suicidal ideation,” and “treatment,” five of which were pertinent to their patient.
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