The MD Program curriculum at the University of Wisconsin School of Medicine and Public Health includes training in evidence-based medicine.
Evidence-based medicine (EBM) has been described as a paradigm shift in the practice of medicine1 and as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."2
Using medical evidence to effectively guide medical practice is important for several reasons. First, clinicians are often asked questions for which the answer is not readily available or is frequently changing. In addition, the amount of medical information is expanding exponentially and absorbing and physicians must develop ways to become lifelong learners, constantly adapting, absorbing and weighing new information.
Patients often expect physicians to interpret and explain medical information that they hear or read about. Insurers expect physicians to know what diagnostic and treatment strategies are cost effective. While students need to rapidly find medical information and assess its quality, they must also learn to make decisions in the absence of good evidence.3 EBM, coupled with excellent communication skills, can be used to meet these challenges.
1. Evidence-Based Medicine Working Group. Evidence-based medicine: a new approach to teaching the practice of medicine. JAMA. 1992;268:2420-5.
2. Sackett DL, Rosenberg WMC, Muir Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn't. BMJ. 1996;312:7172.
3. Welch HG, Lurie JD. Teaching evidence based medicine: caveats and challenges. Acad Med. 2000;75(3):235-40.
Evidence-based medicine learning objectives
- Describe the steps to EBM
- Differentiate between background and foreground knowledge
- Formulate a clinical question in PICO format from a patient scenario
- Recognize types of clinical questions
- Locate clinical evidence using Pubmed clinical query database
- Describe common study designs. Identify the major strengths and limitation of each.
- Identify which study designs are best for answering clinical questions related to therapy/prevention.
- Assess study for validity
- Derive NNT, ARR, RRR, ABI, RBI
- Interpret confidence intervals and p values
- Apply therapy evidence to patients
- Summarize therapy evidence in written report
- Summarize therapy evidence verbally to colleagues
- Summarize and interpret therapy evidence for a patient in terms he/she will understand
- Assess study for validity
- Derive sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios.
- Apply diagnostic evidence to patients
- Summarize diagnostic evidence in written report
- Summarize diagnostic evidence verbally to colleagues
- Summarize and interpret diagnostic evidence for a patient in terms he/she will understand
- Identify common pitfalls to communicating evidence to patients
- Describe the steps to communicating evidence to patients
- Elicit the patient's expectations and concerns
- Find the answer to the patient's question
- Communicate the information
- Check for understanding
- Provide an opportunity for questions
- Provide more information if needed
- Review whether the patient finds that the evidence addresses his or her concern
- Bring the interview to a close