Information Management and Training Residents for “The Future of Family Medicine” Allen F. Shaughnessy, PharmD

Balancing Recommendations STFM Informatics Task Force Residency Review Committee requirements ACGME Outcome Project (Competencies) Future of Family Medicine Report AAFP Recommended Guidelines Goal: To prepare residents... For where the puck is going...

... Maintenance of Certification Evidence of Professional Standing (A valid license) Evidence of cognitive expertise (The Exam) Evidence of a commitment to lifelong learning and involvement in a self- assessment program Evidence of evaluation of performance in practice

Evidence-Based Medicine: Probabilistic Thinking Current paradigm: the biomedical model –The body can be approached as an engineering problem The EBM paradigm: Probabilities –What can we do for people that, on average, will help most of them most of the time?

Evidence-Based Medicine A hierarchy of reliability Evidence from controlled experiments is more credible than conclusions grounded in other sorts of evidence

Information Mastery I mplementing EBM Accessing and using The best available evidence that focuses on outcomes patients care about to inform the care of patients

Where Do We Find this Information? The Usefulness Equation Usefulness = Relevance x Validity of any sourceWork Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):

POEM Patient-Oriented Evidence that Matters matters to you, the clinician, because if valid, will require you to change your practice Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A Guidebook to the Medical Information Jungle. The Journal of Family Practice 1994;39(5):

Highly Controlled Research  Randomized Controlled Trials  Systematic Reviews Physiologic Research Preliminary Clinical Research  Case reports  Observational studies Uncontrolled Observations & Conjecture Effect on Patient-Oriented Outcomes  Symptoms  Functioning  Quality of Life  Lifespan Effect on Disease Markers  A1c in diabetes  MICs in infection  BMD in osteoporosis Effect on Risk Factors for Disease  Improvement in markers (blood pressure, cholesterol) Valid Patient- Oriented Evidence Validity of Evidence Relevance of Outcome

Highly Controlled Research  Randomized Controlled Trials  Systematic Reviews Physiologic Research Preliminary Clinical Research  Case reports  Observational studies Uncontrolled Observations & Conjecture Effect on Patient-Oriented Outcomes  Symptoms  Functioning  Quality of Life  Lifespan Effect on Disease Markers  Diabetes  Arthritis  Peptic Ulcer Effect on Risk Factors for Disease  Improvement in markers (blood pressure, cholesterol) SORT A Validity of Evidence Relevance of Outcome SORT B SORT C Strength of Recommendation Taxonomy

Information Mastery Proficiency Level 0: Decisions based on 3 influences: Patient request, local experts, pharm. reps Level 1: Use the highest quality information to guide clinical decisions (100%) Level 2: Search, evaluate, and make available specialty specific Level 1 information (<1%) Level 3: Create original research (primary) or systematic reviews (secondary)

Teaching Three year “merit badge” model –Specific learning objectives (handout) –Emphasis: Using valid sources to help assess information, rather than reading and assessing the primary literature (impossible!) –Self-directed (Maintenance of certification process) with opportunities for assessment –Longitudinal: Progressive learning of skills, with demonstration of competency over 3 years

Overarching Goals Transition residents from students to learners Teach information management skills for use at the point of care Teach residents to develop a method for self-assessment and learning Become truly independent decision makers