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Alabdullah MN, Alabdullah H, Kamel S. Knowledge, attitude, and practice of evidence-based medicine among resident physicians in hospitals of Syria: a cross-sectional study. BMC MEDICAL EDUCATION 2022; 22:785. [PMID: 36376824 PMCID: PMC9661745 DOI: 10.1186/s12909-022-03840-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Evidence-based medicine (EBM) is to integrate the best research evidence with our clinical expertise, circumstances, and unique values of our patient. However, there are no studies about using EBM in clinical practice among resident doctors in Syria. In this study, we aimed to evaluate the self-reported knowledge, attitude and practice (KAP) of EBM by resident doctors throughout different teaching hospitals in Syria. METHODS The study is a cross-sectional. A self-reported online questionnaire was used to collect data about KAP of EBM from 214 resident physicians working in secondary and tertiary teaching hospitals. The study was conducted between September 2021 and February 2022. All data were analyzed using SPSS, and non-parametric statistical tests were used to identify the correlation between different variables and make the necessary comparisons. RESULTS Two hundred and fourteen physicians responded to the questionnaire with a response rate of 85.6%. The overall mean scores of KAP of EBM were 59.2, 74.3 and 53.9%, respectively. The participants displayed a low level of awareness of resources and statistical terms used in EBM. The most well-known resources for residents were Up To Date and PubMed. Among the participants, pediatric residents achieved the highest score in practicing EBM, while family medicine residents scored the lowest score. CONCLUSION The overall impression about the KAP of EBM among Syrian residents was as following: weak awareness, neutral attitude and poor practice of EBM. Training workshops should be set up to teach residents the skills needed to move from opinion-based practice to evidence-based practice.
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Affiliation(s)
- Muhammad Nour Alabdullah
- Otorhinolaryngology Department, Al-Mowassat University Hospital, Damascus University, Damascus, Syrian Arab Republic
| | - Hadi Alabdullah
- Faculty of Medicine, Hama University, Hama, Syrian Arab Republic
| | - Sondos Kamel
- Faculty of Civil Engineering, Hama University, Hama, Syrian Arab Republic
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Dunbar-Yaffe R, Gold WL, Wu PE. Junior Rounds: an educational initiative to improve role transitions for junior residents. BMC Res Notes 2017; 10:694. [PMID: 29208032 PMCID: PMC5717831 DOI: 10.1186/s13104-017-3027-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022] Open
Abstract
Objective At our institution, Morning Report focuses mostly on diagnostic reasoning. This makes it a challenge for first-year residents to learn to manage common on-call emergencies, such as hyperkalemia. We sought to improve their preparedness for the transitions they would encounter: from medical student to physician at the beginning of the academic year, and from junior resident to senior resident toward the end. In response to feedback, we developed the Junior Rounds curriculum: a weekly session focused on the approach to commonly encountered on-call emergencies and internal medicine referrals. Anonymous surveys were sent to trainees, and iterative analysis of monthly feedback led to changes to Junior Rounds. Results Junior Rounds was implemented from August 2015 to June 2016. Thirty-nine of 92 possible respondents (44%) completed surveys in that period. Most respondents agreed that Junior Rounds met their educational needs, was presented at an appropriate level, and was more important to their learning than other available educational activities. Our experience demonstrates that dedicated time for level-specific learning aimed to support the transitions of junior residents can be successfully achieved. Iterative adjustment to these rounds based on feedback allowed for evolution of the curriculum to meet the changing priorities of junior learners. Electronic supplementary material The online version of this article (10.1186/s13104-017-3027-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard Dunbar-Yaffe
- Division of General Internal Medicine, University of Toronto, Toronto, Canada. .,Toronto General Hospital, 200 Elizabeth St., Eaton Building 13EN-213, Toronto, ON, M5G 2C4, Canada.
| | - Wayne L Gold
- Division of Infectious Diseases and General Internal Medicine, University of Toronto, Toronto, Canada
| | - Peter E Wu
- Division of General Internal Medicine, University of Toronto, Toronto, Canada
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Abu-Gharbieh E, Khalidi DA, Baig MR, Khan SA. Refining knowledge, attitude and practice of evidence-based medicine (EBM) among pharmacy students for professional challenges. Saudi Pharm J 2014; 23:162-6. [PMID: 25972736 PMCID: PMC4421086 DOI: 10.1016/j.jsps.2014.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/10/2014] [Indexed: 11/16/2022] Open
Abstract
Practicing evidence based medicine (EBM) is a professional need for the future clinical pharmacist in UAE and around the world. An attempt was made to evaluate pharmacy student’s knowledge, attitude and proficiency in the practice of EBM. A within-subject study design with pre and post survey and skill test were conducted using case based practice of EBM through a validated questionnaire. The results were tabulated and there was a statistically significant increase in pharmacy students’ perceived ability to go through steps of EBM, namely: formulating PICO questions (95.3%), searching for evidence (97%), appraising the evidence (81%), understanding statistics (78.1%), and applying evidence at point of care (81.2%). In this study, workshops and (Problem Based Learning) PBLs were used as a module of EBM teaching and practices, which has been shown to be an effective educational method in terms of improving students’ skills, knowledge and attitude toward EBM. Incorporating hands on experience, PBLs will become an impetus for developing EBM skills and critical appraisal of research evidence alongside routine clinical practice. This integration would constitute the cornerstone in lifting EBM in UAE up to the needed standards and would enable pharmacy students to become efficient pharmacists that rely on evidence in their health practice.
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Affiliation(s)
- Eman Abu-Gharbieh
- Department of Pharmacology and Toxicology, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Doaa Al Khalidi
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Mirza R Baig
- Department of Clinical Pharmacy and Pharmacy Practice, Dubai Pharmacy College, Dubai, United Arab Emirates
| | - Saeed A Khan
- Department of Pharmaceutical Chemistry and Natural Products, Dubai Pharmacy College, Dubai, United Arab Emirates
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Witman Y. What do we transfer in case discussions? The hidden curriculum in medicine…. PERSPECTIVES ON MEDICAL EDUCATION 2014; 3:113-123. [PMID: 24366760 PMCID: PMC3976482 DOI: 10.1007/s40037-013-0101-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Medical students and junior doctors learn according to the formal curriculum, but they also learn unwritten rules, the specific logic of the medical world, through a socialization process called 'the hidden curriculum'. The result of the process seems to be an exclusive professional identity, the medical habitus. This article underlines the importance of the hidden curriculum in medicine, especially in meetings where patients are discussed. These case discussions, common daily rituals in medical practice, demonstrate the dynamic interaction of learning and practice within the medical world. The article illustrates how medical core values are transferred informally and implicitly, and the role of power relations in this process. Not only are residents being assessed and trained in case discussions, but also staff are assessing each other and learning continuously. Therefore, these meetings might significantly contribute to self-regulation in medicine. The significance of the hidden curriculum should not be underestimated. Insights into the dynamics of case discussions may help medical specialists to make the most of this moment of learning and to avoid the pitfalls, for the benefit of both residents and experienced medical specialists.
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Affiliation(s)
- Yolande Witman
- Postgraduate School in Organization Studies and Change Management, Sioo, Utrecht, the Netherlands,
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Pringle PL, Collins C, Santry HP. Utilization of morning report by acute care surgery teams: results from a qualitative study. Am J Surg 2014; 206:647-54. [PMID: 24157348 DOI: 10.1016/j.amjsurg.2013.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rigor of handoffs is increasingly scrutinized in the era of shift-based patient care. Acute care surgery (ACS) embraced such a model of care; however, little is known about handoffs in ACS programs. METHODS Eighteen open-ended interviews were conducted with ACS leaders representing diverse geographic and practice settings. Two independent reviewers analyzed interviews using an inductive approach to elucidate themes regarding use of morning report (using NVivo qualitative analysis software). RESULTS Twelve of 18 respondents reported using morning report, but only 6 of 12 included attending surgeon-to-attending surgeon handoffs. One of 12 incentivized attending surgeons to participate, 2 of 12 included nursing staff members, and 2 of 12 included physician extenders. Cited benefits of morning report were safe and effective information exchange (2 of 12), quality improvement (2 of 12), multidisciplinary discussion (1 of 12), and resident education (2 of 12). Three of 12 respondents cited time commitment as the main limitation of morning report. CONCLUSIONS Morning report is underused among ACS programs; however, if implemented strategically, it may improve patient care and resident education.
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McNeill M, Ali SK, Banks DE, Mansi IA. Morning report: can an established medical education tradition be validated? J Grad Med Educ 2013; 5:374-84. [PMID: 24404299 PMCID: PMC3771165 DOI: 10.4300/jgme-d-12-00199.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 01/08/2013] [Accepted: 03/13/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Morning report is accepted as an essential component of residency education throughout different parts of the world. OBJECTIVE To review the evidence of the educational value, purpose, methods, and outcomes of morning report. METHODS A literature search of PubMed, Ovid, and the Cochrane Library for English-language studies published between January 1, 1966, and October 31, 2011, was performed. We searched for keywords and Medical Subject Heading terms related to medical education, methods, attitudes, and outcomes in regard to "morning report." Title and abstract review, followed by a full-text review by 3 authors, was performed to identify all pertinent articles. RESULTS We identified 71 citations; 40 articles were original studies and 31 were commentaries, editorials, or review articles; 56 studies (79%) originated from internal medicine residency programs; 6 studies (8%) focused on ambulatory morning report; and 63 (89%) originated from the United States. Identified studies varied in objectives, methods, and outcome measures, and were not suitable for meta-analysis. Main outcome measures were resident satisfaction, faculty satisfaction, preparation for professional examinations, use of evidence-based medicine, clinical effects on patient care, adverse event detection, and utilization of a curriculum in case selection. CONCLUSIONS Morning report has heterogeneous purposes, methods, and settings. As an educational tool, morning report is challenging to define, its outcome is difficult to measure, and this precludes firm conclusions about its contribution to resident education or patient care. Residency programs should tailor morning report to meet their own unique educational objectives and needs.
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Boushehri E, Khamseh ME, Farshchi A, Aghili R, Malek M, Ebrahim Valojerdi A. Effects of morning report case presentation on length of stay and hospitalisation costs. MEDICAL EDUCATION 2013; 47:711-716. [PMID: 23746160 DOI: 10.1111/medu.12152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/14/2013] [Indexed: 06/02/2023]
Abstract
CONTEXT The primary goal of discussing patient cases during the morning report is to teach appropriate clinical decision making. In addition, the selection of the best diagnostic strategy and application of evidence-based patient care are important. Reducing hospital costs is fundamental to controlling inflation in health care costs, especially in university hospitals that are subject to budget constraints in developing countries. The goal of this study was to explore the effect of morning report case presentation on length of stay (LoS) and hospitalisation costs in a university teaching hospital. METHODS A total of 54 patients whose cases had been presented at morning report sessions in the department of internal medicine during a 3-month period (presented group) were selected and their medical records reviewed for data on final diagnosis, hospital LoS and detailed hospital costs. A control group of 104 patients, whose cases had not been presented, were selected on the basis that their final diagnoses matched with those of the presented group. In addition, the groups were matched for age, sex, occupation, comorbidities and insurance coverage. Final diagnoses were based on International Classification of Disease 10 (ICD-10) diagnostic code criteria. RESULTS The mean ± standard deviation (SD) hospital LoS was 8.32 ± 4.11 days in the presented group and 10.46 ± 4.92 days in the control group (p = 0.045). Mean ± SD hospitalisation costs per patient were significantly lower in the presented group (US$553.43 ± 92.16) than the control group (US$1621.93 ± 353.14) (p = 0.004). Although costs for paraclinical services were similar, there were very significant reductions in costs for medications used during hospitalisation and bed-days (p = 0.002). CONCLUSIONS Discussing clinical aspects of patient cases in morning report sessions facilitates the management process and has a significant effect on LoS and hospitalisation costs in patients admitted to hospital.
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Affiliation(s)
- Elham Boushehri
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
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Alahdab F, Firwana B, Hasan R, Sonbol MB, Fares M, Alnahhas I, Sabouni A, Ferwana M. Undergraduate medical students' perceptions, attitudes, and competencies in evidence-based medicine (EBM), and their understanding of EBM reality in Syria. BMC Res Notes 2012; 5:431. [PMID: 22882872 PMCID: PMC3520748 DOI: 10.1186/1756-0500-5-431] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/07/2012] [Indexed: 11/21/2022] Open
Abstract
Background Teaching evidence-based medicine (EBM) should be evaluated and guided by evidence of its own effectiveness. However, no data are available on adoption of EBM by Syrian undergraduate, postgraduate, or practicing physicians. In fact, the teaching of EBM in Syria is not yet a part of undergraduate medical curricula. The authors evaluated education of evidence-based medicine through a two-day intensive training course. Methods The authors evaluated education of evidence-based medicine through a two-day intensive training course that took place in 2011. The course included didactic lectures as well as interactive hands-on workshops on all topics of EBM. A comprehensive questionnaire, that included the Berlin questionnaire, was used to inspect medical students’ awareness of, attitudes toward, and competencies’ in EBM. Results According to students, problems facing proper EBM practice in Syria were the absence of the following: an EBM teaching module in medical school curriculum (94%), role models among professors and instructors (92%), a librarian (70%), institutional subscription to medical journals (94%), and sufficient IT hardware (58%). After the course, there was a statistically significant increase in medical students' perceived ability to go through steps of EBM, namely: formulating PICO questions (56.9%), searching for evidence (39.8%), appraising the evidence (27.3%), understanding statistics (48%), and applying evidence at point of care (34.1%). However, mean increase in Berlin scores after the course was 2.68, a non-statistically significant increase of 17.86%. Conclusion The road to a better EBM reality in Syria starts with teaching EBM in medical school and developing the proper environment to facilitate transforming current medical education and practice to an evidence-based standard in Syria.
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Khader YS, Batayha W, Al-Omari M. The effect of evidence-based medicine (EBM) training seminars on the knowledge and attitudes of medical students towards EBM. J Eval Clin Pract 2011; 17:640-3. [PMID: 21114803 DOI: 10.1111/j.1365-2753.2010.01604.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is debate about the most effective method for teaching evidence-based medicine (EBM) in medical schools. This study was conducted to evaluate the effect of integration of EBM training seminars into the curriculum of the community medicine course in changing the knowledge and attitudes of the fourth year medical students towards EBM. METHODS This is a quasi-experimental study conducted on the fourth year medical students who joined the community medicine mandatory summer course at Jordan University of Science and Technology in the period between July 1 and August 31, 2008. We measured medical students' self-reported attitudes about and knowledge of EBM before the integration of EBM seminars into the community medicine course and at the end of course. RESULTS A high proportion of students had positive attitude towards EBM before and after the course. After the course, the vast majority (91.8%) became aware of the presence of guidelines and protocols for diseases compared with 59.0% who were aware of that before (P < 0.005). Only small proportion of students reported that they understand and able to explain the common epidemiological concepts that are used in EBM before the training. After the training, a significantly higher proportion of students reported understanding the epidemiological concepts. CONCLUSION Integration of EBM training course into community course for the fourth year students improved their EBM knowledge. Longitudinal studies are needed to evaluate the long-term effects of EBM curriculum in changing behaviours, practice patterns and patient care outcome.
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Affiliation(s)
- Yousef S Khader
- Faculty of Medicine, Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan.
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Taheri H, Mirmohamadsadeghi M, Adibi I, Ashorion V, Sadeghizade A, Adibi P. Evidence-based Medicine (EBM) for Undergraduate Medical Students. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n9p764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Introduction: Teaching evidence-based medicine (EBM) to practitioners and residents will improve their performance. There is insufficient evidence regarding the teaching of EBM in undergraduate medical education. We aimed to determine whether an EBM workshop would improve undergraduate medical student’s ability to form clinical questions and search databases, as well as their attitudes towards EBM.
Material and Methods: This was a quasi-experimental study on fifth- and sixth-year medical students of Isfahan University of Medical Sciences. In a 4day workshop, students learned and practised how to form clinical questions, perform literature searches and carry out critical appraisals. We assessed the student’s ability to form a clinical question and their performance in searching and identifying the best clinical literature to answer the question, before and after the workshop. Students’ attitudes were assessed using the Likert scale 15-item questionnaire on the last day of the workshop. Wilcoxon signed ranks test was performed to compare pre- and post-tests.
Results: The workshop increased students’ scores in developing clinical questions (P = 0.004, mean rank = 14) and search skills (P <0.001, mean rank = 12.50). It also improved students’ attitudes towards EBM [mean = 3.76, (standared deviation = 0.7)]. The course allowed students (79.2%) to appreciate the need for EBM education for medical students. The students also commented that the course showed them the importance of EBM knowledge in effective clinical performance.
Conclusions: EBM workshop for undergraduate medical students increased their ability to form clinical questions and carry out appropriate literature searches. It also improved their attitudes towards learning and applying EBM.
Key words: Attitudes, Clinical performance, Evidence-Based medicine, Knowledge, Workshop
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Affiliation(s)
- Hajar Taheri
- Isfahan University of Medical Science, Isfahan, Iran
| | | | - Iman Adibi
- Isfahan University of Medical Science, Isfahan, Iran
| | | | | | - Peiman Adibi
- Isfahan University of Medical Science, Isfahan, Iran
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Sanfey H, Stiles B, Hedrick T, Sawyer RG. Morning report: combining education with patient handover. Surgeon 2008; 6:94-100. [PMID: 18488775 DOI: 10.1016/s1479-666x(08)80072-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The advent of resident work hour restrictions has challenged us to train residents within a shorter working week, while ensuring continuity of patient care. We instituted morning report (MR) at the University of Virginia primarily as a means to accomplish these objectives. Serendipitously MR has become an integral educational tool for the surgical residents. The rationale for the format and instructional design are discussed in the context of learning theory. METHODS The chief residents as primary stakeholders were strongly encouraged to play a leadership role in designing MR. A faculty- led didactic format was rejected because of the importance of focusing on resident team building, and leadership, but poor faculty participation was also an issue. RESULTS The initial obstacles included timing, and designing the format. CONCLUSIONS MR is an opportunity for residents to exercise and improve their knowledge, leadership, presentation and problem-solving skills. We would hypothesise that the advantages for teaching are many and include that residents are prepared for actual clinical problems in a supportive environment with opportunities for immediate feedback and assessment. Reports of educational effectiveness of MR are mostly anecdotal and further studies are needed to characterise the types of learning and teaching that occur during MR and to document educational effectiveness.
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Affiliation(s)
- H Sanfey
- Department of Surgery, University of Virginia Health System, Charlottesville 22908, USA.
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Rahnavardi M, Bikdeli B, Vahedi H, Alaei F, Pourmalek F, Amini A, Rahnavardi A. Morning report: a survey of Iranian senior faculty attitudes. Intern Emerg Med 2008; 3:17-24. [PMID: 18256889 DOI: 10.1007/s11739-008-0091-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 07/19/2007] [Indexed: 11/28/2022]
Abstract
Morning report (MR) is a universal component of internal medicine training. Despite its omnipresence, little is known about senior faculty attitudes toward MR. We aimed to survey expert attitudes towards MR. Using an 85-item self-administered questionnaire, we made a survey of medical education-trained faculty members (FMs) who participated in and presented articles at the Seventh National Iranian Congress on Medical Education, 12-15 November 2005, Tabriz, Iran, on the processes of teaching and learning during MR (n=175). Among the 111 FMs (63.4%) who completed the survey, education was the most frequently cited goal of the MR. Clinical wisdom and the ability to expand a resident's differential diagnosis skills were the attributes most often proposed as essential for the FMs. Respondents believed the FM in cooperation with the senior resident of the last duty (41%) or the senior resident of the last duty alone (40%) should select the presenting cases. The study participants stated that 41% of the MR should be spent discussing common cases, 33% in the area of expertise of the FM and 26% in discussing rare or interesting cases. A common opinion was that treatment recommendations should be based on the medical literature. In terms of the educational impact of activities during the MR, listing differential diagnoses and bedside visits to examine unique findings scored the highest. Education as the main goal of the MR can best be achieved by expanding residents' skills in differential diagnosis and in making decisions using an evidence-based, self-directed method.
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Affiliation(s)
- Mohammad Rahnavardi
- Educational Development Center, Artesh University of Medical Sciences, West Dr Fatemi Boulevard, Tehran, Iran.
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Banks DE, Shi R, Timm DF, Christopher KA, Duggar DC, Comegys M, McLarty J. Decreased hospital length of stay associated with presentation of cases at morning report with librarian support. J Med Libr Assoc 2007; 95:381-7. [PMID: 17971885 DOI: 10.3163/1536-5050.95.4.381] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The research sought to determine whether case discussion at residents' morning report (MR), accompanied by a computerized literature search and librarian support, affects hospital charges, length of stay (LOS), and thirty-day readmission rate. METHODS This case-control study, conducted from August 2004 to March 2005, compared outcomes for 105 cases presented at MR within 24 hours of admission to 19,210 potential matches, including cases presented at MR and cases not presented at MR. With matching criteria of patient age (+/- 5 years), identical primary diagnosis, and secondary diagnoses (within 3 additional diagnoses) using International Classification of Diseases (ICD-9) codes, 55 cases were matched to 136 controls. Statistical analyses included Student's t tests, chi-squared tests, and nonparametric methods. RESULTS LOS differed significantly between matched MR cases and controls (3 days vs. 5 days, P < 0.024). Median total hospital charges were $7,045 for the MR group and $10,663 for the control group. There was no difference in 30-day readmission rate between the 2 groups. DISCUSSION/CONCLUSION Presentation of a case at MR, followed by the timely dissemination of the results of an online literature review, resulted in a shortened LOS and lower hospital charges compared with controls. MR, in association with a computerized literature search guided by the librarians, was an effective means for introducing evidence-based medicine into patient care practices.
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Affiliation(s)
- Daniel E Banks
- Department of Medicine, Louisiana State University School of Medicine, Shreveport, LA 71130, USA.
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General surgery morning report: a competency-based conference that enhances patient care and resident education. ACTA ACUST UNITED AC 2007; 63:385-90. [PMID: 17084766 DOI: 10.1016/j.cursur.2006.06.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Revised: 05/28/2006] [Accepted: 06/13/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE After adopting a night float system, the residency program at the University of Virginia Health System Department of Surgery initiated a daily morning report (MR). The conference was originated to sign out new admissions and consults from the previous day to the services that would assume care. Although initially oriented toward transfer of patient information, MR is also hypothesized to serve as a competency-based resident education tool. METHODS An anonymous survey was distributed to on-service residents (n = 25). Questions were asked on a 5-point Likert scale. Respondents also ranked the weekly conferences, including MR, in terms of educational benefit derived. RESULTS Most residents agreed that MR is an efficient method to sign-out patient care [84% stongly agree (SA) or agree (A)] and that it provides an excellent educational experience (88% SA or A). They agreed that it is presented in an evidence-based format (88% SA or A). Regarding the core competencies, residents all asserted that MR addresses "patient care" (100% SA or A) and "medical knowledge" (100% SA or A). Most agreed that it addresses "professionalism" (60% SA or A), "interpersonal skills and communication" (76% SA or A), and "practice-based learning and improvement" (92% SA or A). The 4 most important components identified with respect to continuing to improve both patient care and resident education were the presence of the on-call attending, a review of relevant radiology, provision of follow-up on select cases, and critical review of the literature. On average, MR was seen as the most educational conference, with 52% of residents ranking it first. CONCLUSIONS Although MR is ubiquitous in most primary care residency programs, such a conference has not typically been held on surgical services. The MR was developed at the University of Virginia Health System Department of Surgery as a necessity for patient sign-out. As this conference has continued to evolve, it has become an excellent tool for resident education. It now serves the purpose of enhancing patient care and medical education and of providing evidence of learning and assessment of the general competencies. The MR provides an example for program directors of how to tailor existing resident work sessions or conferences to meet Accreditation Council for Graduate Medical Education (ACGME) competency requirements.
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Hatala R, Keitz SA, Wilson MC, Guyatt G. Beyond journal clubs. Moving toward an integrated evidence-based medicine curriculum. J Gen Intern Med 2006; 21:538-41. [PMID: 16704406 PMCID: PMC1484798 DOI: 10.1111/j.1525-1497.2006.00445.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Incorporating evidence-based medicine (EBM) into clinical practice is an important competency that residency training must address. Residency program directors, and the clinical educators who work with them, should develop curricula to enhance residents' capacity for independent evidence-based practice. In this article, the authors argue that residency programs must move beyond journal club formats to promote the practice of EBM by trainees. The authors highlight the limitations of journal club, and suggest additional curricular approaches for an integrated EBM curriculum. Helping residents become effective evidence users will require a sustained effort on the part of residents, faculty, and their educational institutions.
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Affiliation(s)
- Rose Hatala
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Krahn J, Sauerland S, Rixen D, Gregor S, Bouillon B, Neugebauer EAM. Applying evidence-based surgery in daily clinical routine: a feasibility study. Arch Orthop Trauma Surg 2006; 126:88-92. [PMID: 16402196 DOI: 10.1007/s00402-005-0095-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Indexed: 02/09/2023]
Abstract
BACKGROUND Although the word evidence-based medicine (EBM) has gained wide popularity, only a few studies have evaluated how EBM works in clinical practice. METHODS We have prospectively evaluated the feasibility of evidence-based trauma surgery. Orthopaedic trauma surgeons were asked to produce clinical questions related to the treatment of current patients. An informaticist searched the literature (Medline, Cochrane Library, practice guidelines and textbooks) and reported the findings on every following day. The study's main endpoints were the rate of questions for which relevant evidence (>level V) was available and the time necessary to find and critically appraise medical evidence. RESULTS In total, 44 EBM questions were formulated, mainly concerning treatment options. PubMed was searched for 39 questions, textbooks for 14, the Cochrane Library for 11, online guidelines for 9 and other sources were used for 4 questions. On average, 157 text items (three per questions) were identified as potentially relevant. Journal articles predominated (83%) over textbooks (10%). Sixty-eight percent of the questions (30 of 44) were answered, either on the basis level 1 (n=13 questions), level 2 (n=6), or level 4 evidence (n=14). Trying to answer a question required 53 min on average, split up between 39 min of database searches and 25 min of obtaining full text articles. In four cases, the evidence suggested a change in clinical management. The physicians were very appreciative of our project and found the provided evidence very helpful for their clinical decisions. CONCLUSIONS Time will be the main barrier against the introduction of clinical EBM. It is likely that clinicians reduce EBM to those situations where evidence is likely to be found. Although the impact of EBM on patient-care was limited, the concept of EBM was successfully implemented.
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Affiliation(s)
- Jan Krahn
- Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, Cologne, Germany
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West CP, Kolars JC, Eggert CH, Kennedy CC, Ficalora RD. Changing morning report: evaluation of a transition to an interactive mixed-learner format in an internal medicine residency program. TEACHING AND LEARNING IN MEDICINE 2006; 18:330-5. [PMID: 17144839 DOI: 10.1207/s15328015tlm1804_10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Morning report is an important conference for medical education, but direct comparisons of approaches to morning report have only rarely been reported. DESCRIPTION During the 2003 to 2004 academic year, we conducted both our traditional single-learner-level morning report and a new highly interactive multiple-learner-level format. Attendees were rotating students, residents, and faculty on the inpatient general medicine services. EVALUATION We conducted anonymous surveys of participants to record their evaluations of the morning report formats. We received evaluations from 293 (60%) of 490 students, residents, and faculty. Students, 1st-year residents, and faculty preferred the mixed-learner model significantly more than did senior residents. Overall, more than 80% of participants rated the interactive multilevel format as good or very good when asked about content, discussion quality, level, and usefulness. CONCLUSIONS An interactive morning report involving learners across multiple levels was well-received and has several educational benefits, with a greater emphasis on collaborative case discussion and active learning. Education leaders should remain open to experimenting with even the most well-established institutional traditions as they continuously reevaluate the effectiveness of teaching conferences.
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Affiliation(s)
- Colin P West
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Lucas BP, Evans AT, Reilly BM, Khodakov YV, Perumal K, Rohr LG, Akamah JA, Alausa TM, Smith CA, Smith JP. The impact of evidence on physicians' inpatient treatment decisions. J Gen Intern Med 2004; 19:402-9. [PMID: 15109337 PMCID: PMC1492243 DOI: 10.1111/j.1525-1497.2004.30306.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment), but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated whether physicians would change inpatient treatment if presented with the results of a literature search. DESIGN Before-after study. SETTING Large public teaching hospital. PARTICIPANTS Random sample of 146 inpatients cared for by 33 internal medicine attending physicians. INTERVENTIONS After physicians committed to a specific diagnosis and treatment plan, investigators performed standardized literature searches and provided the search results to the attending physicians. MEASUREMENTS AND MAIN RESULTS The primary study outcome was the number of patients whose attending physicians would change treatment due to the literature searches. These changes were evaluated by blinded peer review. A secondary outcome was the proportion of patients who received evidence-based treatment before and after the literature searches. Attending physicians changed treatment for 23 (18%) of 130 eligible patients (95% confidence interval, 12% to 24%) as a result of the literature searches. Overall, 86% of patients (112 of 130) received evidence-based treatments before the searches and 87% (113 of 130) after the searches. Changes were not related to whether patients were receiving evidence-based treatment before the search (P =.6). Panels of peer reviewers judged the quality of patient care as improved or maintained for 18 (78%) of the 23 patients with treatment changes. CONCLUSIONS Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment.
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Affiliation(s)
- Brian P Lucas
- Department of Medicine, John H Stroger, Jr. Hospital of Cook County and Rush Medical College, Chicago, IL 60612, USA.
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Kamei RK, Sectish TC. Evaluating a Residency Program Using Reflections of Recent Resident Graduates and their Pediatric Colleagues. MEDICAL EDUCATION ONLINE 2003; 8:4330. [PMID: 28253154 DOI: 10.3402/meo.v8i.4330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND PURPOSES In response to the new Accreditation Council for Graduate Medical Education (ACGME) mandate for residency programs to use feedback to improve its educational program, we piloted a novel evaluation strategy of a residency program using structured interviews of resident graduates working in a primary care practice and their physician associates. METHODS A research assistant performed a structured telephone interview. Quantitative data assessing the graduate's self-assessment and the graduate's clinical practice by the associate were analyzed. In addition, we performed a qualitative analysis of the interviews. RESULTS Thirteen resident graduates in primary care practice and seven physician practice associates participated in the study. Graduate self-assessment revealed high satisfaction with their residency training and competency. The associates judged our graduates as highly competent and mentioned independent decision-making and strong interpersonal skills (such as teamwork and communication) as important. They specifically cited the graduate's skills in intensive care medicine and adolescent medicine as well as communication and teamwork skills as important contributions to their practice. CONCLUSIONS The ACGME Outcomes Project, which increases the emphasis on educational outcomes in the accreditation of residency education programs, requires programs to provide evidence of its effectiveness in preparing residents for practice. Direct assessment of the competency of our physician graduates in practice using structured interviews of graduates and their practice associates provide useful feedback information to a residency program as part of a comprehensive evaluation plan of our program's curriculum and can be used to direct future educational initiatives of our training program.
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Affiliation(s)
- Robert K Kamei
- a Department of Pediatrics University of California San Francisco School of Medicine San Francisco , CA
| | - Theodore C Sectish
- b Department of Pediatrics Stanford University School of Medicine Palo Alto , CA
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Baum KD. The Impact of an Evidence-Based Medicine Workshop on Residents' Attitudes towards and Self-Reported Ability in Evidence-Based Practice. MEDICAL EDUCATION ONLINE 2003; 8:4329. [PMID: 28253169 DOI: 10.3402/meo.v8i.4329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Evidence-based medicine (EBM) is a part of many medical school and residency curricula worldwide, but there is little research into the most effective methods to teach these skills. PURPOSE To evaluate whether a course on EBM utilizing adult learning principals leads to both immediate and short-term attitudinal, confidence, and behavioral change. METHODS Seventy-three (73) Internal Medicine and Internal Medicine/Pediatric residents attended a half-day seminar on EBM. Participants completed pre- and post-course 5-point Likert questionnaires, and set two personal goals for integrating EBM into their daily practice. We performed nonparametric two -sample Wilcoxon Rank-Sum tests to compare responses. We also elicited the self-reported success of the residents in meeting their goals one-month post-course. RESULTS Attitudes about EBM improved (3.5 pre-course vs. 3.7 post-course), as well as selfreported EBM skills (3.0 vs. 3.3). Seventy-two percent of residents reported having met at least one of their two goals for the integration of EBM into their practice. CONCLUSIONS An EBM workshop based upon adult learning principles was successful in meeting multiple educational goals. The links between andragogy, learners' internal drive for behavior change, and successful EBM education should be further explored.
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Affiliation(s)
- Karyn D Baum
- a Assistant Professor Department of Internal Medicine University of Minnesota Minneapolis, MN 55455
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Srinivasan M, Weiner M, Breitfeld PP, Brahmi F, Dickerson KL, Weiner G. Early introduction of an evidence-based medicine course to preclinical medical students. J Gen Intern Med 2002; 17:58-65. [PMID: 11903776 PMCID: PMC1494995 DOI: 10.1046/j.1525-1497.2002.10121.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Evidence-based Medicine (EBM) has been increasingly integrated into medical education curricula. Using an observational research design, we evaluated the feasibility of introducing a 1-month problem-based EBM course for 139 first-year medical students at a large university center. We assessed program performance through the use of a web-based curricular component and practice exam, final examination scores, student satisfaction surveys, and a faculty questionnaire. Students demonstrated active involvement in learning EBM and ability to use EBM principles. Facilitators felt that students performed well and compared favorably with residents whom they had supervised in the past year. Both faculty and students were satisfied with the EBM course. To our knowledge, this is the first report to demonstrate that early introduction of EBM principles as a short course to preclinical medical students is feasible and practical.
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Affiliation(s)
- Malathi Srinivasan
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
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Callahan M, Fein O, Battleman D. A practice-profiling system for residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2002; 77:34-39. [PMID: 11788320 DOI: 10.1097/00001888-200201000-00008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Providers are increasingly evaluated and measured as part of quality, credentialling, and reimbursement programs, an approach often used by managed care organizations. However, these evaluations are rarely used in residency training, meaning that physicians entering practice have little experience or understanding of these measures. To address this issue, in 1998 the authors successfully developed a three-part practice-profiling system for internal medicine residents at their institution that includes measures of patient satisfaction, disease-management profiles for diabetes and hypertension, and an Internet-based faculty-evaluation program. The patient-satisfaction profile utilizes a ten-question patient survey that emphasizes physician-patient communication issues. The diabetes and hypertension disease-management profiles use the resident's own patients to profile process and outcome measures for common chronic ambulatory conditions. The faculty-evaluation profile is conducted over the Internet, and allows the resident to compare faculty evaluations with those of his or her peer group. Residents receive the profiles as a packet in a scheduled session with a faculty supervisor twice each year. A total of 120 residents are profiled annually for the above measures. Residents rated the program very highly, and found the profiling program to be instructive and effective feedback. As payers and regulators increasingly use physician profiling, residents will benefit from learning the strengths and weaknesses of profiling systems early in their training.
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Affiliation(s)
- Mark Callahan
- Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Medical College of Cornell University (WMC-CU), New York, NY, USA.
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Haidet P, O'Malley KJ, Richards B. An initial experience with "team learning" in medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2002; 77:40-44. [PMID: 11788321 DOI: 10.1097/00001888-200201000-00009] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Team learning is an approach to large-group teaching that combines the strengths of small-group interactive learning with teacher-driven content delivery. Team learning has been used successfully in professional disciplines other than medicine. The authors describe a field test of team learning in the setting of an internal medicine residency noontime lecture in the spring of 2000 at Baylor College of Medicine. They surveyed residents on their attitudes toward the usefulness of the lecture content before and after the session and surveyed them on their engagement in learning. Residents reported their engagement as high and demonstrated favorable changes in their attitudes about the usefulness of the lecture content to their daily medical practice. The authors describe their adaptation of the team-learning approach and conclude that team learning may be a useful new pedagogic tool in medical education.
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Affiliation(s)
- Paul Haidet
- Houston Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, Texas 77030, USA.
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Knight JR, Frazer CH, Goodman E, Blaschke GS, Bravender TD, Emans SJ. Development of a Bright Futures curriculum for pediatric residents. AMBULATORY PEDIATRICS : THE OFFICIAL JOURNAL OF THE AMBULATORY PEDIATRIC ASSOCIATION 2001; 1:136-40. [PMID: 11888390 DOI: 10.1367/1539-4409(2001)001<0136:doabfc>2.0.co;2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To develop a standardized case-based curriculum for pediatric residents on child growth, development, behavior, and adolescent medicine that incorporates the Bright Futures health supervision guidelines. DESIGN This project included a needs assessment, development of a list of important topics, writing and revising of standardized cases, formative evaluation of cases, and efficacy pilot testing of 2 cases. SETTING A large pediatric teaching hospital continuity clinic. PARTICIPANTS Pediatric residents, fellows, and faculty. INTERVENTIONS Preparation of standardized cases, facilitator training, and resident-led teaching conferences. OUTCOME MEASURES Learner and facilitator evaluation forms and two 10-item diagnostic skills assessments. RESULTS During the project, faculty-fellow teams wrote 29 case-teaching modules. All participants gave high ratings to cases, and resident facilitators reported increased comfort with the case discussion method. Resident learners' ability to accurately interpret developmental screening tests and growth charts improved following sessions on those topics. CONCLUSIONS Further evaluation is required, but these standardized cases appear promising for teaching pediatric residents. The curriculum is now freely available to faculty nationwide.
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Affiliation(s)
- J R Knight
- Divisions of General Pediatrics, Childrens Hospital, Boston, MA 02115, USA.
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Demopoulos B, Pelzman F, Wenderoth S. Ambulatory morning report: an underutilized educational modality. TEACHING AND LEARNING IN MEDICINE 2001; 13:49-52. [PMID: 11273380 DOI: 10.1207/s15328015tlm1301_9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Many medicine residency training programs include a lecture-based preclinic conference series as part of the ambulatory educational curriculum when more effective teaching formats might be available. Our institution has replaced this lecture-based teaching format with an ambulatory morning report modeled after the inpatient paradigm. This study compares the efficacy of these 2 teaching models and defines the desired characteristics of this new teaching strategy. DESCRIPTION We first conducted a background study by obtaining permission to use test questions from the Medical Knowledge Self-Assessment Program to develop pre- and postambulatory rotation tests to validate our ambulatory curriculum. Forty-three of 44 interns completed both pre- and postambulatory block testing. The mean score on these tests improved from 67% to 81%. Although this overall improvement achieved statistical significance, test question subgroup analysis clearly indicated that the improved knowledge in test items relating to our preclinic conference topics contributed negligibly to the overall statistical improvement. As such, we ultimately replaced our preclinic conference with a morning report format. In this study, 82 residents were enrolled in a 2-year prospective observational study. This study group completed an ambulatory curriculum in which the 1st year was completely lecture based, and the 2nd year included the morning report format. We were thus able to survey residents' opinions regarding the effectiveness of the 2 very different teaching formats used in consecutive years. EVALUATION The survey results from those residents exposed to both teaching formats over 2 years revealed a high degree of satisfaction with the ambulatory morning report format. When comparing the long-term educational value, 94% of the residents found the morning report format more effective than the lecture-based preclinic conference. In addition, many desirable characteristics of the morning report also were defined. CONCLUSIONS Lecture-based preclinic conferences might not be the most effective way of conveying information over the long term. Residents seem to prefer the more interactive morning report format. When organizing such a teaching format, attention should be directed toward the characteristics that were felt to be desirable by those we are trying to teach.
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Affiliation(s)
- B Demopoulos
- Department of Clinical Medicine, Weill Medical College of Cornell University, 505 East 70th Street, New York, New York, 10021 USA
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Spickard A, Ryan SP, Muldowney JA, Farnham L. Outpatient morning report: a new conference for internal medicine residency programs. J Gen Intern Med 2000; 15:822-4. [PMID: 11119176 PMCID: PMC1495611 DOI: 10.1046/j.1525-1497.2000.91109.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To clarify the use of outpatient morning report in internal medicine residency programs, we conducted a national survey of internal medicine residency directors and a local survey of a cohort of residents at a large teaching hospital. The program directors reported a 24% prevalence of outpatient morning report. The cohort of residents reported that the conference contributed much to their education by meeting specific learning needs and covering topics not covered elsewhere in their residency training.
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Affiliation(s)
- A Spickard
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn 37232, USA.
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Amin Z, Guajardo J, Wisniewski W, Bordage G, Tekian A, Niederman LG. Morning report: focus and methods over the past three decades. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2000; 75:S1-S5. [PMID: 11031158 DOI: 10.1097/00001888-200010001-00002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Z Amin
- K.K. Women's and Children's Hospital, Singapore.
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Smith CA, Ganschow PS, Reilly BM, Evans AT, McNutt RA, Osei A, Saquib M, Surabhi S, Yadav S. Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability. J Gen Intern Med 2000; 15:710-5. [PMID: 11089714 PMCID: PMC1495601 DOI: 10.1046/j.1525-1497.2000.91026.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To measure the effectiveness of an educational intervention designed to teach residents four essential evidence-based medicine (EBM) skills: question formulation, literature searching, understanding quantitative outcomes, and critical appraisal. DESIGN Firm-based, controlled trial. SETTING Urban public hospital. PARTICIPANTS Fifty-five first-year internal medicine residents: 18 in the experimental group and 37 in the control group. INTERVENTION An EBM course, taught 2 hours per week for 7 consecutive weeks by senior faculty and chief residents focusing on the four essential EBM skills. MEASUREMENTS AND MAIN RESULTS The main outcome measure was performance on an EBM skills test that was administered four times over 11 months: at baseline and at three time points postcourse. Postcourse test 1 assessed the effectiveness of the intervention in the experimental group (primary outcome]; postcourse test 2 assessed the control group after it crossed over to receive the intervention; and postcourse test 3 assessed durability. Baseline EBM skills were similar in the two groups. After receiving the EBM course, the experimental group achieved significantly higher postcourse test scores (adjusted mean difference, 21%; 95% confidence interval, 13% to 28%; P < .001). Postcourse improvements were noted in three of the four EBM skill domains (formulating questions, searching, and quantitative understanding [P < .005 for all], but not in critical appraisal skills [P = .4]). After crossing over to receive the educational intervention, the control group achieved similar improvements. Both groups sustained these improvements over 6 to 9 months of follow-up. CONCLUSIONS A brief structured educational intervention produced substantial and durable improvements in residents' cognitive and technical EBM skills.
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Affiliation(s)
- C A Smith
- Department of Medicine, Cook County Hospital and Rush Medical College, Chicago, Ill. 60612, USA.
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Abstract
PURPOSE Little is known about how often residents encounter unanswered clinical questions in their training. This knowledge would facilitate the development of curricula to help residents practice evidence-based medicine. This study was conducted to determine the frequency, characteristics, and pursuit of residents' clinical questions. SUBJECTS AND METHODS Residents in a university-based primary care internal medicine program were observed in two hospital-based teaching clinics. Residents were interviewed after each patient encounter to determine whether they had any remaining clinical questions. At the end of each clinic session, they recorded their level of agreement with a series of statements about factors that were expected to motivate residents to seek the answers to each question. One week later, residents were contacted to determine if they had pursued these questions. RESULTS Sixty-four residents were interviewed after 401 (99%) of 404 patient encounters. They identified 280 new questions, approximately 2 questions for every 3 patients. The most common types of questions were related to therapy (38%) or diagnosis (27%). The residents were subsequently contacted about 277 (99%) of their questions. Of these, only 80 (29%) were pursued, most commonly by consulting textbooks (31%), original articles (21%), or attending physicians (17%). In a multivariable analysis, belief that the patient expected the answer (odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.3 to 4.0, P = 0.004) and fear of malpractice exposure (OR = 2.1, 95% CI: 1.0 to 4.3, P = 0.05) were associated with information pursuit. Lack of time (60%) and forgetting the question (29%) were the most frequent reasons for failing to pursue a question. CONCLUSION Residents frequently encountered new clinical questions in the outpatient clinic, but infrequently answered them. Efforts to demonstrate the feasibility of timely searches, remind them of their questions, and reinforce the exigency (educational if not clinical) of all questions may reclaim missed opportunities for self-directed learning.
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Affiliation(s)
- M L Green
- Yale Primary Care Residency Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06721, USA
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Abstract
Evidence-based medicine (EBM) training remains a challenge to educators, particularly in graduate medical education. In this article, I trace the history of EBM in American medical education, review traditional journal clubs and contrast them to free-standing EBM curricula, petition for the advancement of integrated EBM teaching and propose an agenda for future work. Traditional journal clubs are unsuitable to teach evidence-based decision making because of their exclusive focus on critical appraisal. In contrast, EBM curricula cover the identification, appraisal and application of evidence in the context of individual patient scenarios. The effectiveness of some recent efforts reflects increasing attention to curriculum development principles and scientific rigour. The integration of EBM training into residents' established clinical venues offers theoretical educational advantages and confronts the challenge of practising EBM under the imperatives of 'real time' patient care. Initial responses to this formidable challenge show promise, but their feasibility and effectiveness remain to be explored. A more complete understanding of the epidemiology of residents' emerging clinical questions will inform continued curriculum development in integrated EBM training.
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Affiliation(s)
- M L Green
- Yale University School of Medicine, Department of Internal Medicine, New Haven, CT, USA
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Abstract
To characterize evidence-based medicine (EBM) curricula in internal medicine residency programs, a written survey was mailed to 417 program directors of U.S. internal medicine residency programs. For programs offering a freestanding (dedicated curricular time) EBM curriculum, the survey inquired about its objectives, format, curricular time, attendance, faculty development, resources, and evaluation. All directors responded to questions regarding integrating EBM teaching into established educational venues. Of 417 program directors, 269 (65%) responded. Of these 269 programs, 99 (37%) offered a freestanding EBM curriculum. Among these, the most common objectives were performing critical appraisal (78%), searching for evidence (53%), posing a focused question (44%), and applying the evidence in decision making (35%). Although 97% of the programs provided MEDLINE, only 33% provided Best Evidence or the Cochrane Library. Evaluation was performed in 37% of the freestanding curricula. Considering all respondents, most programs reported efforts to integrate EBM teaching into established venues, including attending rounds (84%), resident report (82%), continuity clinic (76%), bedside rounds (68%), and emergency department (35%). However, only 51% to 64% of the programs provided on-site electronic information and 31% to 45% provided site-specific faculty development. One third of the training programs reported offering freestanding EBM curricula, which commonly targeted important EBM skills, utilized the residents' experiences, and employed an interactive format. Less than one half of the curricula, however, included curriculum evaluation, and many failed to provide important medical information sources. Most programs reported efforts to integrate EBM teaching, but many of these attempts lacked important structural elements.
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Affiliation(s)
- M L Green
- Yale Primary Care Residency Program, Yale University School of Medicine, Department of Internal Medicine, New Haven, CT 06721, USA.
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Michael Elnicki D, Halperin AK, Shockcor WT, Aronoff SC. Multidisciplinary Evidence-Based Medicine Journal Clubs: Curriculum Design and Participants' Reactions. Am J Med Sci 1999. [DOI: 10.1016/s0002-9629(15)40514-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Elnicki DM, Halperin AK, Shockcor WT, Aronoff SC. Multidisciplinary evidence-based medicine journal clubs: curriculum design and participants' reactions. Am J Med Sci 1999; 317:243-6. [PMID: 10210360 DOI: 10.1097/00000441-199904000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence-based medicine (EBM) is becoming an accepted educational paradigm in medical education at a variety of levels. It focuses on identifying the best evidence for medical decision making and applying that evidence to patient care. METHODS Three EBM journal clubs were developed at the West Virginia University School of Medicine. One was for senior medical students, another for residents, and the third for primary care faculty members. In each, the sessions stressed answering clinical questions arising from actual patient-care issues. The curricular structure and development of the journal clubs are described. Participants anonymously evaluated aspects of the journal clubs regarding their educational value with Likert scale questions. RESULTS Faculty members and residents generally gave high evaluations to all aspects of the EBM journal clubs. Student evaluations were more mixed. For each of the evaluation questions, the student means were lower than those of faculty and residents. However the differences reached statistical significance only in the responses to the usefulness of the sessions in understanding the medical literature (P < 0.01). Residents and faculty rated the EBM sessions more favorably than grand rounds or the resident lecture series. CONCLUSIONS The establishment of evidence-based medicine journal clubs is feasible, and learners seem to value the sessions. More developed learners may gain more from the experience than those earlier in their medical education.
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Affiliation(s)
- D M Elnicki
- Department of Medicine, West Virginia University, Morgantown 26506, USA.
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Moores KG. Evidence-Based Practice in Health Care. J Pharm Pract 1998. [DOI: 10.1177/089719009801100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health care practice requires managing large amounts of information. Rapid advances are occurring in available evidence regarding effectiveness and efficiency of various health care services. The health care practitioner must have information management skills plus access to resources and technology. Evidence-based medicine is a philosophy of practice and an approach to decision making that values systematic evidence. There are many similarities in evidence-based practice and the systematic approach to drug information. New information resources and informatics technologies are available, and changes are occurring in health professional education that support an evidence-based practice. Implementation of principles and tools of evidence-based medicine are expected to improve the quality, effectiveness, and efficiency of care.
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Affiliation(s)
- Kevin G. Moores
- Kevin G. Moores, PharmD, Director, Iowa Drug Information Network, Assistant Professor (Clinical), The University of Iowa College of Pharmacy, 100 Oakdale Campus, N344 OH, Iowa City IA 52242-5000, Phone. 319 335-4800 Fax. 319 335-4440 e-mail
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