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Tips for Using Experience-Based, Integrative Evidence-Based Medicine (EBM)
Teaching with an EBM approach fosters development of the skills needed to bring the most current information to the real-time practice of medicine. With the advent of reliable, evidence databases that provide screened meta-analyses and systematic reviews, a residency director might wonder which skills are most needed and most practical. Do residents need to be able to perform a systematic review of the primary research, or should they instead focus attention on learning to access already-prepared systematic reviews and integrate “best evidence” into the care of their patients? Unfortunately, there is little evidence in the literature to help us answer this question. Residency Directors do not need to make this choice, however, because both methods may be learned during a three-year residency program. The educational research examining the implementation of EBM curricula suggests the following:
- There is little evidence to support that the conclusion that learning EBM as a “content area” through didactics alone (or even through journal clubs) encourages residents to use EBM in their practices. EBM must be integrated into clinical practice on the wards and in the clinics.
- Faculty members need both to embrace the EBM approach to teaching medicine and to model its use in their own practice. Some ways to do this might be to:
- cite systematic reviews when lecturing and expect residents to do the same when presenting;
- keep an updated file of systematic reviews in your area of practice, update it quarterly, and use it while precepting; (Residents may also be responsible for updating a “practice database.”)
- use computer resources (both online and CD-ROM) on site;
- expect “evidence” to be part of morning report, ambulatory rounds, work rounds, etc.;
- model integrating “best evidence” with expert opinion and the specific needs of patients; and
- model “communicating best evidence” with patients.
Key References (Click here for selected references list on this topic)
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