Transcript Slide 1

The appraisal and assimilation of
scientific evidence, and its
application to patient care: A key
competency in the design of the
professional curriculum
Robert H. Roswell, M.D.
Senior Associate Dean and Professor of
Medicine, College of Medicine
Adjunct Professor of Health Administration
and Policy, College of Public Health
Explosion of Medical Knowledge
Amount of Medical
Literature
2006
1850
1900
1950
Year
2000
2050
Can we continue to use a
traditional approach to train
physicians in view of this growth?
NO!
ACGME General Competencies
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Patient Care
ACGME General Competencies
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Patient Care
Medical Knowledge
ACGME General Competencies
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Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
ACGME General Competencies
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Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
ACGME General Competencies
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Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
Professionalism
ACGME General Competencies
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Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
Professionalism
Systems-based practice
ACGME General Competencies
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Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
Professionalism
Systems-based practice
Practice-based Learning and
Improvement: required skills
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Analyze own practice for needed
improvements
Practice-based Learning and
Improvement: required skills
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Analyze own practice for needed
improvements
Use of evidence from scientific studies
Practice-based Learning and
Improvement: required skills
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Analyze own practice for needed
improvements
Use of evidence from scientific studies
Application of research and statistical
methods
Practice-based Learning and
Improvement: required skills
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Analyze own practice for needed
improvements
Use of evidence from scientific studies
Application of research and statistical
methods
Use of information technology
Practice-based Learning and
Improvement: required skills
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Analyze own practice for needed
improvements
Use of evidence from scientific studies
Application of research and statistical
methods
Use of information technology
Facilitate learning of others
Towards Evidence Based Medicine
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Access to relevant literature
Towards Evidence Based Medicine
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Access to relevant literature
Critical evaluation of quality of evidence
Towards Evidence Based Medicine
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Access to relevant literature
Critical evaluation of quality of evidence
Meta-analysis
Towards Evidence Based Medicine
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Access to relevant literature
Critical evaluation of quality of evidence
Meta-analysis
Formulation of EBM Guidelines
Towards Evidence Based Medicine
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Access to relevant literature
Critical evaluation of quality of evidence
Meta-analysis
Formulation of EBM Guidelines
Incorporation of EBM into Health
Information Systems
JAMA. 2005;293:1223-1238.
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Effects of Computerized Clinical
Decision Support Systems on
Practitioner Performance and Patient
Outcomes
Amit X. Garg, MD; Neill K. J. Adhikari, MD;
Heather McDonald, MSc; M. Patricia RosasArellano, MD, PhD; P. J. Devereaux, MD;
Joseph Beyene, PhD; Justina Sam, BHSc; R.
Brian Haynes, MD, PhD
JAMA. 2005;293:1223-1238.
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Methods
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We included English-language randomized
and nonrandomized trials with a
contemporaneous control group that
compared patient care with a CDSS to
routine care without a CDSS and evaluated
clinical performance (ie, a measure of
process of care) or a patient outcome.
JAMA. 2005;293:1223-1238.
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Results
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From 3997 screened citations, we retrieved
226 full-text articles, and 100 trials met our
criteria for review.
JAMA. 2005;293:1223-1238.
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Results
Practitioner performance improvement
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Overall
Diagnostic systems
Reminder systems
Disease management
Drug-dosing or prescribing
64%
40%
76%
62%
66%
JAMA. 2005;293:1223-1238.
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Conclusions
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Many CDSSs improve practitioner
performance, however their effects on
patient outcomes are less clear.
Summary
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EBM will be essential to successfully
manage the continued rapid growth of
medical literature
Summary
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EBM will be essential to successfully
manage the continued rapid growth of
medical literature
EBM must be an integral part of
physician training
Summary
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EBM will be essential to successfully
manage the continued rapid growth of
medical literature
EBM must be an integral part of
physician training
EBM offers great promise to improve
care delivery and patient outcomes