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Example 3
Scenario: Using an experience-based integrative EBM approach to teach Practice-based Learning and Improvement during administrative conferences.
You are the chief resident in a busy general surgery residency program. You and your residency faculty advisor have been asked to suggest ways to improve teamwork and reduce the number of medical errors attributed to failure of teamwork in the residency program. You remember hearing a presentation at the Surgical Education conference about how improving team communication reduced errors and improved patient satisfaction. You wonder whether communication skill training would help solve these problems in your residency.
The illustration below describes how you may address Practice-Based Learning and Improvement learning objectives during administrative conference time. The learning objectives are that residents will be able to: (a) search for evidence to answer a focused question; (b) critically appraise the evidence; and (c) incorporate scientific evidence into decisions and plans for improving patient care.
Illustration:
Although EBM is typically used to help make informed decisions about patient care practices, systematic reviews related to a wide range of topics are also appearing in EBM databases. In this example, you and your faculty advisor decide to use an administrative resident meeting to approach a group practice and communication problem from an EBM perspective. You and your advisor determine that including all residents in this process will increase participation should they find confirming evidence. At the resident administrative meeting, you lead a short discussion on the problem, state the question, and divide the residents into two teams. Using the computers provided, both teams of residents find systematic reviews (Cochrane Database of Systematic Reviews) and primary research addressing this subject in less than five minutes. The first of six systematic reviews includes behavior change as well as attitude change as outcomes, and presented 12 studies that met criteria as controlled studies. From this evidence, the residents agreed that communication training across the health care team was worth pursuing. You and your faculty advisor take the recommendation to the Residency Director.
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