MINIMAL CRITERIA FOR APPROVING EVIDENCE-BASED MEDICINE
(EBM) COURSES FOR THE RESIDENT BY THE SAUDI COUNCIL OF HEALTH SPECIALTIES
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This document is
prepared for the Saudi Council For Health Specialties (SCHS) to decide the
standards that should be fulfilled by any center that aims to conduct a
training course on Evidence Based Medicine (EBM). This is essential before
being approved by the SCHS.
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Contents:
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1. Duration
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2. Human
and other resources
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3. Learning
Outcomes
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4. Process
of teaching
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5. Methods
of Teaching
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6. Assessment
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7. Application
form
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8. References
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1.
Duration
3 days
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Either three days course or 2 ½ days course + one half day assessment
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Seven Hours/day
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2. Human
and other resources
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A.
Human Resources
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One trainer (Instructor) per 8 candidates or
less.
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All trainers should have attended a basic EBM
course and preferably "teaching the teachers" course.
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It is preferably if one trainer or librarian
attended a course on searching or has sufficient searching skills.
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Twelve candidates or less per group (small
group teaching)
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B.
Other arrangements and resources
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One computer with live internet connection
per two candidates or less.
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The material should be sent for candidates at
least one week before the course.
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A space enough for small group discussion and
OSCE examination
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Access or subscription to some or all of the
following databases: Cochrane Library, PubMed, CLINICAL EVIDENCE, Evidence
Based Medicine, ACP Journal Club, trip database, Up to date, SUM Search, and
GACGUIDELINES.
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3. Learning
outcomes
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At the end of the course, the
candidates should have been familiar to the following competencies, which are
based on the five steps of EBM.
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Translation of uncertainty in to
an answerable question. The student identifies knowledge gaps during the course of practice
and asks foreground questions to fill these gaps. The student should ask
focused questions that lead to effective search and appraisal strategies.
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Search for and retrieval of
evidence. The
student can design and conduct a search strategy to answer questions. The student understands the strengths and weaknesses of the
different sources of evidence.
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Critical appraisal of evidence
for validity and clinical importance. The student can appraise the validity of a study. The
appraisal will include: the suitability of the type of study to the type of
question asked, the reliability of outcome measures chosen, and the
suitability and robustness of the analysis employed. The student can appraise
the importance of the outcomes and translate them into clinically meaningful
summary statistics, such as number needed to treat (NNT). The course should
cover the therapy, diagnosis, and systematic review (Meta analysis) studies.
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Application of appraised evidence
to practice. The
student can assess the relevance of the appraised evidence to the need that
prompted the question. The student can explore the patient's values and the
acceptability of the answer.
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Evaluation of performance. After the student had asked the
focused question(s), searched sources of evidence, appraised or used
pre-appraised evidence and applied these in practice, (S)he would reflect on
how well these activities were performed.
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4. Process
of teaching:
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EBM Steps
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No. of Hours
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Theory
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1.
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Translation of
uncertainty into an answerable question.
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2
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2.
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Search for and
retrieval of evidence.
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4
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3.
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Critical appraisal
of evidence for validity and clinical importance.
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9
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4.
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Application of
appraised evidence to practice.
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3
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5.
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Evaluation of
performance.
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3
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It should be noticed
that at least 60% of each of the steps allocated time should be in the form
of practical (either hands on or small groups discussions) and not more than
40% on the didactic sessions (theory)
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5. Methods
of Teaching
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It is advisable to
follow the following guidelines for the process of teaching. They are
arranged in the sequence of the EBM steps:
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Translation of
uncertainty in to an answerable question.
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Presenting clinical
scenarios or asking candidates to share a problem encountered in their
clinical practice. Framing a focused, answerable question in a structured
format(2). Several formats are taught: 3 part
(patient-intervention/exposure-comparator-outcome), or 5 part
(patient-intervention/exposure- comparator-outcome-time) questions.
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Search for and
retrieval of evidence.
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Theoretical
instruction backed by a supervised practical session (hands-on medical
websites search)) with online connection(3). A librarian with
search skills could be utilized for this purpose if possible. A variety of
databases should be shown as possible with the strengths and weaknesses
discussed. Examples include Cochrane Library, PubMed, CLINICAL EVIDENCE,
Evidence Based Medicine, Upto date, ACP Journal Club, trip database, SUM
Search and GACGUIDELINES but Minimal two are required: one primary unfiltered
website (e.g. PubMed) and one secondary filtered one (e.g. cochrane library)
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Critical appraisal of
evidence for validity and clinical importance.
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This is probably the
most widely taught skill [5] Examples include the Critical Appraisals Skills
Program(4).
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Application of
appraised evidence to practice.
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Examples include
applying the identified evidence to the specific context that led to the
quest for evidence. This requires exploration of the generalisability of the
evidence to the specific scenario, and 'particularizing outcomes by adjusting
for patient-specific risks (5).
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Evaluation of
performance
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Role modeling by the
attending senior physicians and /or EBP teachers. The encouragement of adult
learning styles and Journal clubs(6).
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6. Assessment
(Optional):
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·
While the majority of the group agreed on the
benefit of evaluating the workshops by the participants. However it was
agreed that, for the time being, the formative assessment is optional. The
benefits of formative assessments are a lot including feedback to the
teachers and course organizers and feedback to the participants on their
strong and weak points.
·
Computer based OSCE has been used elsewhere
to test the abilities of framing questions, searching, and retrieving
appropriate evidence(8).
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The assessment for
each EBM step is as follow:
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1. One or more station
covering step 1: Translation of uncertainty into an answerable
question as follows: -
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The skills can be
assessed by presenting a clinical scenario and asking the student to form a
focused, answerable question (included in the Fresno test)(7). This could be done by presenting the
question on the screen or in paper and ask the whole group to answer at the
same time.
One or more question
(station) covering step 2 as follows: Search for and retrieval of evidence.
This could be done by either giving the search assigned at the end of 2nd
day and asking them to bring on the 3rd day or in the form of
computer based OSCE
One or more station
covering step 3 as follows: Critical appraisal of evidence for validity and
clinical importance.
Tests
for critical appraisal of validity including the Fresno test and others, or giving them an
article to appraise overnight or during the working day.
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2. One or more station
covering step 4 as follows: Application of appraised
evidence to practice. Objective
structured clinical examination (OSCE) involving clinical application and
interaction with patient after reading supplied evidence(10).
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3. One or more station
covering step 5 as follows: Evaluation of performance.
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Use of a questionnaire to assess
knowledge, attitude and behavior(11).
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4. Assignment (optional
for courses and the participants):- It is a strong
educational tool. Each candidate could write a (500-1000) words EBM report.
The report describes the experience of the candidate in the application of
the five steps of EBM for a clinical question. The candidate should reflect
on how well these activities were performed and what conclusions and lessons
were learned
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7. Application
Form
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You
can download the application form for For Conducting EBM WORKSHOP for
residents & fellows according to SCHS requirements (ref 1763/3 dated
6/4/1426H) by clicking on the following link:
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Application form
Mandatory Requirement for EBM Workshops directed to Residents and Fellows:
 Registration
form
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8. References
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1.
Dowes M, Sumnerskill W, Glasziou P, Cartabellota A. et al. Sicily statement on
evidence-based practice. BMC Medical Education 2005, 5:1
2.
Richardson WS, Wilson MC, Nishikawa J, Hayward RS: The
well-built clinical question: a key to evidence-based decisions [editorial].
ACP J Club 1995, 123:A 12-3.
3.
Rosenberg WM, Deeks J, Lusher A, Snowball R, Dooley G, Sackett
D: Improving searching skills and evidence retrieval. J R Coll Physicians
Lond 1998, 32: 557-563.
4.
CASP: http:/www.phru.nhs.uk/casp..
5.
Straus SE, Sackett DL: Applying evidence to the individual
patient. Ann Oncol 1999, 10: 29-32.
6.
Sackett DL, Straus S, Richardson WS, Rosenberg W, Haynes B:
Evidence-Based Medicine. How to Practice and Teach EBM. Edinburgh, Churchill
Livingstone; 2000.
7.
Ramos KD, Schafer S, Tracz SM: Validation of the Fresno test of
competence in evidence based medicine. BMJ 2003, 326: 19-321.
8.
Fliegel JE, Frohna JG, Mangrulkar RS: A computer-based OSCE
station to measure competence in evidence-based medicine skills in medical
students. Acad Med 2002, 77: 1157-1158.
9.
Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer HH, Kunz R: Do
short courses in evidence based medicine improve knowledge and skills?
Validation of Berlin questionnaire and before and after study of courses in
evidence based medicine. BMJ 2002, 325: 1338-1341.
10.
Bradlley P, Humphris G: Assessing the ability of medical
students to apply evidence in practice: the potential of the OSCE. Med Educ
1999, 33: 815-817.
11.
Johnston JM, Leung GM, Fielding R, Tin KYK, Ho LM: The
development and validation of a knowledge, attitude and behavior
questionnaire to assess undergraduate evidence-based practice teaching and
learning. Med Edu 2003, 37: 992-1000.
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