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Example 2
Scenario: Using a “real-time” EBM approach to teach Practice-Based Learning and Improvement and to increase Medical Knowledge on the in-patient service.
You are a faculty member in a large pediatric residency program, and have been asked by the director to coordinate the “evidence-based medicine” curriculum. You would like to demonstrate that while actively seeing patients, residents may practice evidence-based medicine. The residents are skeptical that this can be accomplished in the time allotted.
The illustration below describes how you may address Practice-Based Learning and Improvement and Medical Knowledge learning objectives on the in-patient wards. The objectives are that residents (1) will obtain current, evidence-based information about the treatment of common medical conditions (Medical Knowledge); and (2) will be able to: (a) formulate a good clinical question; (b) efficiently search for appropriate evidence and guidelines of care; (c) critically appraise the evidence; and (d) decide whether evidence and guidelines apply to the care of a specific patient (Practice Based Learning and Improvement).
Illustration:
During a patient care session in the clinic, you are supervising a resident. His patient is a six-year-old child with recurrent otitis media. Using an EBM approach to teaching, you want to demonstrate that new information on common problems is published every day. You ask the resident the following questions: “What is the most sensitive clinical examination finding for otitis media?” and “When should a child be referred for PE tubes?” The resident is unsure, and together you focus a new question: “What are the indications for PE tubes therapy for recurrent otitis media in a six year-old child?” A computer with Worldwide Web access in the supervision room allows you to search for recent guidelines published on the subject using the National Guideline Clearinghouse (NGC) and Cochrane Database. The answer was available after a four-minute search of the NGC. You then review the guidelines and the associated grading system, and consider whether the guidelines are relevant for this patient and clinical setting. In another residency setting that does not have ready access to the Worldwide Web, you could use CD ROM materials, which are updated quarterly and may be used to answer common medical questions. By gathering and using these resources, residents learn new knowledge and sharpen their critical appraisal skills while improving the outcomes for patients.
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