On Thursday and Friday November 19-20, I attended a workshop on evidence-based practice with members of the PCC Davenport Clinician Early Adopter Group, which was held at the University of Iowa Medical School. The course spent much of its time introducing faculty clinicians to a set of concepts drawn from evidence-based practice, including sensitivity and specificity of diagnostic tests, likelihood ratios, relative risk and odds ratios. All were presented in the context of clinical training. This workshop was led by Dr. Mark Wilson, the director of graduate medical education for University of Iowa. Mark has devoted much of the past decade to becoming an excellent instructor in EBP, and he has played a role in the development of the program on teaching EBP at McMaster University. As part of the program, Mark focused on strategies to help weave EBP into clinical teaching, and the following ideas are drawn from his work and should be credited to him. Mark has offered the following points among others he suggests (1):
1. To teach EBP, you have to use it in your own clinical practice. This is an important point, which recognizes that you will become better at teaching this concept as you become more comfortable with using it yourself. As you progress in your knowledge and confidence, you will find better ways in which to approach how you can teach. Familiarity breeds better responses from you when questioned by your students.
2. Assess your learner’s EBP readiness. Keep mindful that your initial enthusiasm may not be matched by your student’s. Learn to gauge their readiness on a daily basis.
3. Diagnosis both the patient and the learner. You, as a clinical teacher, need to be attuned to the information your patient gives the learner, and you need to be equally attuned to how the learner processes what they are told. You are therefore focusing on diagnosing the patient, while at the same time doing something similar for the student’s learning.
4. Select which clinical question(s) to pursue. When working up a patient, realize that it may not be possible to consider every issue you might want. Help your student interns focus on ones that they need to answer, and which serve as wise learning points.
5. Cultivate curiosity by showing your own and celebrating it in others. It is okay to note that you do not have an answer, but that you will look it up and share it with others; when you do so, be enthusiastic so that you model a form of behavior which will serve the learner well in practice.
6. Bite off less than you can chew. I remember Mark making this point quite clearly. He is recognizing that we have only so much time to do what we need, and he recommends that we keep the learning to manageable amounts. And tailor this to each individual student.
7. Use pre-appraised evidence resources. There are numerous excellent sources of evidence and information that we can direct our students to. For example, the LRC just added DynaMed to its battery of online resources, and this is an excellent source of summarized information about hundreds of medical conditions. Better yet, it can be used at point of care.
8. Emphasize interpreting and applying evidence. Show your students how you use the evidence you find. Model the best clinical behavior so that others can see how this is done well.
9. Exploit the learning opportunity, not the learner. Share in the activity of gathering and applying evidence.
10. And last, mark suggests that you “be fearless.” Get out there and do it, and don’t worry if you feel you lack mastery; you have to start and get going. You’ll get better the more you do it.
As we get ready for a short break this week, I would like to wish you all a happy holiday and a restful few days off.
1. Wilson M, Richardson WS. Top strategies to weave EBM into your clinical teaching. Handout. Palmer teaching faculty, November 20, 2009