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Teaching Evidence Assimilation for Collaborative Health Care

Teaching Evidence Assimilation for Collaborative Health Care Building Capacity for Scientifically Informed Healthcare Peter Wyer MD Co-Chair, Section on Evidence Based Health Care New York Academy of Medicine Department of Medicine, Columbia University Medical Center. ACKNOWLEDGEMENTS.

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Teaching Evidence Assimilation for Collaborative Health Care

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  1. Teaching Evidence Assimilation for Collaborative Health Care Building Capacity for Scientifically Informed Healthcare Peter Wyer MD Co-Chair, Section on Evidence Based Health Care New York Academy of Medicine Department of Medicine, Columbia University Medical Center

  2. ACKNOWLEDGEMENTS

  3. TEACHING EVIDENCE ASSIMILATION FOR COLLABORATIVE HEALTHCARE External Support Generous Donation of Electronic Resources: Annals of Internal Medicine (ACP Journal Club) BMJ Group (Clinical Evidence, Best Practice, EB Journals) Cochrane Collaboration (Cochrane Library) EBSCO (Dynamed, CINAHL) Elsevier (Clinical Key) McGraw-Hill-JAMA (JAMAEvidence) Wolters-Kluwer (Joanna Briggs)

  4. SPEAKERS, COURSE DIRECTORS AND PLANNING COMMITTEE MEMBERS REPORTING NO RELEVANT FINANCIAL RELATIONSHIPS WITH COMMERCIAL INTERESTS TO DISCLOSE: DISCLOSURE OF FINANCIAL RELATIONSHIPS

  5. The TEACH Design • Basic foundational skills • Developing clinical recommendations within specific healthcare settings • Knowledge creation and implementation

  6. Common Skills Across Dimensions • Problem delineation • Formulating information needs • Finding the most relevant evidence • Appraising evidence quality and importance • Integration with practice-based evidence • Assimilation of resulting knowledge into clinical and systems actions

  7. TEACH • Evidence Assimilation • Collaborative Health Care

  8. “Knowledge does not extend from those who consider they know to those who consider they do not know. Knowledge is built in the relationship between human beings and perfects itself in the critical problematization of these relations.” Paulo Freire

  9. Silva, Charon Wyer J Eval Clin Pract 2011

  10. Narrative Evidence Based Medicine • NM: ‘Story telling and receiving as a clinical discipline’ • EBM: Information literacy within clinical medicine • NEBM: Clinical information literacy nested within NM • Attention/Representation/Affiliation

  11. Who Decides? Early Models of Evidence-Based Medicine Clinical Expertise Research Evidence Clinical State and Circumstances Patient Preferences Clinical Expertise Patient Preferences and Actions Research Evidence Haynes et al. ACP J Club, 1996:125:A-14-16 Haynes et al. ACP J Club, 2002: 136:A-11-14 Wyer Silva J Eval Clin Pract 2009

  12. Relationship Centered Care • 1993-94: Pew Commission/Fetzer Institute • Tasked to integrate psychosocial and biomedical issues in health care • Epistemologically defined construct • Polanyi: tacit dimension • Merleau-Ponty: predecessor of complexity theory • Explicitly aligned with established tendencies • Schon: Reflective action • Engel: Biopsychosocial model

  13. Relationship Centered Care • Extended applications of RCC-Pew/Fetzer • Complexity theory in health care organizations • Critique of methodology of research into health care communications and interactions • Integration of relationship-based and evidence-based care • Additional elaborations • Connection to organizational knowledge creation (Nonaka) • Affinity with social constructivism (Freire) Wyer, Silva Post Quinlan J Eval Clin Pract 2014

  14. Punch Lines • Evidence serves, it is not served • “In the struggle between yourself and the world-back the world” (Franz Kafka) • “The way out is through the door” (Confucious)

  15. Reflections of Rationalism • Guidelines are not used • Patients do not get evidence-based care • Regulatory indicators fail to correlate with tangible improvements in the value of health services • QI projects lead to paper trails and work-around • Shared decision making seen as a tool for evidence transfer • Relational skills = a sub-specialty of practice

  16. Remedies • Starting knowledge creation at the point of knowledge use • Starting implementation by engaging end-user needs • Including patient perspectives in research design (PCOR) • Including relational principles in the “EBM” curriculum

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