The Evidence-Based Medicine Teaching Program

I thought I would take an opportunity during one of our breaks to post here about the course of our conference. I am in Hamilton, Ontario taking a week-long course on how to effectively teach the concepts of evidence-based medicine or evidence-based practice. It is being taught or facilitated by some of the leaders in this discipline, including Gordon Guyatt, Deborah Cook and Tom McGinn. The program is organized into both large-group and small-group sessions, usually with the large-group meetings held earlier in the morning, and the small group sessions from mid-morning until late afternoon. Because I am the sole chiropractor here, I have been involved with the small group that is comprised of medical internal medicine specialists, and they have been a warm and welcoming group with a sincere interest in knowing about chiropractic.

The large-group sessions touch on general topics, but the real work takes place in the small-group setting. Each physician is asked to make a presentation to their group, in which they take a pre-assigned paper and go through its elements with the group. They are provided feedback on how well they teach that material, the strategies they use in teaching the information, how well they draw out members of the group, and how well they make sense of difficult concepts. We have had a heavy emphasis in our group on certain EBM concepts, notably relative risk, number needed to treat, and the difference between intention-to-treat analysis and loss to follow-up. These jargon terms sound complicated, but working through each paper helps to illuminate the importance of these concepts and how they can be used to inform decision-making in clinical practice. I chose to present a systematic review, since I have some experience with them, and I was also allowed to replace the medical review with one I selected from the chiropractic literature. It took more than 90m minutes to critique the paper, during which a great many questions came about issues such as translating the dense information into clinical action, how to conduct meaningful reviews, and how to evaluate the quality of the literature that is selected from inclusion. It went quite well.

Ultimately, the tools, strategies and approaches I learn here will be an aid to helping our own faculty gain mastery over these concepts and then apply them in the clinical setting or the classroom. I am looking forward to that. It has been an incredibly intense time here, but it has also been great fun. And our instructors certainly practice what they preach, both in the classroom and in clinical practice.