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Evidence-Based Medicine: A Foundation and Partnership for EBBM

Evidence-Based Medicine: A Foundation and Partnership for EBBM. Jason M. Satterfield, Ph.D. Associate Professor Director, Behavioral Medicine Div of Gen Internal Medicine. Emergence of Evidence-Based Medicine. 1910 Flexner report

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Evidence-Based Medicine: A Foundation and Partnership for EBBM

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  1. Evidence-Based Medicine: A Foundation and Partnership for EBBM Jason M. Satterfield, Ph.D. Associate Professor Director, Behavioral Medicine Div of Gen Internal Medicine

  2. Emergence of Evidence-Based Medicine 1910 Flexner report 1972 Archie Cochrane – Effectiveness and Efficiency 1972 RWJ Clinical Scholars Program 1982 Clinical Epidemiology (McMaster U) Clinical decision theory 1984 American College of Medical Informatics 1990 “Scientific medicine” and Evidence-based medicine 1992-3 Cochrane Collaboration

  3. The 5 Step EBM Model • Formulate the question • Search for answers • Appraise the evidence • Apply the results • Assess the outcome

  4. “Evidence-Based Capitulation” • Practicing clinicians are too busy to use all EBM steps will all patients • Increased focus on pithy clinical practice guidelines, synopses, and structured abstracts • ACP Journal Club • Cochrane database • “Up-to-date”

  5. Pedagogy: How is EBM Taught? • Teaching EBP is about teaching a process – not just what tx have empirical support Journal clubs • Preceptorships/clinical supervision • Embedded throughout a curriculum • Role models demonstrate daily application

  6. EBM: Top Lessons Learned • Buy-in from key stakeholders is essential for local adoption and national dissemination • EBM is a lifelong learning skill and not memorization of tx guidelines • Teaching should use active clinical cases with opportunities for practice and revision • The roles of clinical experience and patient values need to be emphasized often and integrated with best evidence

  7. Mistakes when teaching EBM • Teaching EBM fails: • When learning how to do research is emphasised over how to use it • When learning how to do statistics is emphasised over how to interpret them • When teaching EBM is limited to finding flaws in published research • When teaching portrays EBM as substituting research evidence for, rather than adding it to clinical expertise, patient values and circumstances

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