Learning And Teaching Evidence Based Medicine Asking And

Learning And Teaching Evidence Based Medicine: Asking And Answering a Clinical Question Christopher Bunt, MD, FAAFP Kimberly Jarzynka, MD, FAAFP

Disclosures: Nothing to disclose. Do. D Disclaimer: The views expressed in this presentation are those of the authors and do not necessarily reflect the official policy or position of the Air Force at-large, the Department of Defense or the U. S. Government.

Objectives • Foreground vs. Background questions • PICO framework • EBM Resources • Practice as a group

What is EBM? • Primary research literature sources – Randomized Controlled Trials (RCTs) – Meta-analyses – Systematic Reviews (Cochrane Reviews) – Clinical Practice Guidelines (CPGs)

What is NOT EBM? • Most Secondary Resources – Up. To. Date © – General review articles – Textbooks • Other stuff – Wikipedia – Google

Background vs. Foreground • Background Questions – General knowledge – Who, what, how? • Foreground Questions – PICO Model

ASK the Question: PICO Model • Patient/Problem – Can be individual or a group • Intervention – Can be new or old therapy • Control – Can be watchful waiting (doing nothing) • Outcome – Want to focus on patient oriented outcomes

Patient vs. Disease-Oriented Outcomes • Patient – Morbidity – Mortality – Cost – Symptoms • Disease – Blood pressure – Lab test results – Radiologic findings

Why do we care? • The #1 way to answer your clinical question is to create an answerable question. • Creating a foreground question using the PICO format will guarantee that you will have the best chance to answer your question.

Background vs. Foreground • What are the diagnostic tests for Lyme disease? • BACKGROUND • In a patient with suspected Lyme disease, is the immediate clinical treatment or test-andthen-treat approach better for morbidity? • FOREGROUND

Background vs. Foreground • Who can get an IUD? • BACKGROUND • Is immediate IUD insertion after childbirth effective and safe? • FOREGROUND

Background vs. Foreground • Every clinical question can be both a background a foreground question • Both can be useful in clinical practice • Foreground questions will allow you to complete a successful critical appraisal

Answering your PICO Where can I start?

http: //www. essentialevidenceplus. com • Point of care resource – synthesized, valid, reliable, LOE, concise, bottom line • • • Daily POEMs Alerts, weekly podcasts Mobile optimized CME available $88 per year for individual subscription 30 day free trial

https: //dynamed. ebscohost. com/ • Point of care resource – synthesized, valid, reliable, LOE, bulleted text • • • Updated daily Dyna. Med EBM Focus newsletters weekly Mobile app (Skyscape medical) CME available $395 per year (less for residents, students) 30 day free trial

http: //pubmedhh. nlm. nih. gov/ • Point of care resource – primary literature • • • Uses PICO format to search MEDLINE/Pub. Med Narrow by publication type Link to full-text article (save or email) Mobile app Free

Practice with the PICO Model • Review synopsis • • Patient/Problem Intervention Control Outcome

Practice with PICO • Please download Pub. Med 4 HH app or access website: http: //pubmedhh. nlm. nih. gov/nlmd/pico/pic onew. php • Search and see what you can find!

Objectives • Foreground vs. Background questions • PICO framework • EBM Resources • Practice as a group

Questions? • Christopher. bunt@usuhs. edu Visit the Family Medicine Clerkship Curriculum for more info on how to teach the PICO model. http: //www. stfm. org/cci/index. cfm