Incorporating Evidence-Based Medicine in the Residency Curriculum Katelin M. Lisenby, PharmD, BCPS Catherine P. Scarbrough, MD, FAAFP Melanie T. Tucker, PhD Dana G. Carroll, PharmD, BCPS, CDE University of Alabama Family Medicine Residency

Disclosures We have nothing to disclose

Objectives Identify barriers to evidence-based medicine (EBM) Identify active learning methods Describe evaluation methods utilized Identify barriers to residents learning and practicing evidence-based medicine (EBM) Identify active learning methods to enhance resident utilization, assessment, interpretation, and application of the medical literature for cost-effective, evidence-based, patient care decisions Describe methods utilized to evaluate the EBM curriculum and resident learning and progress along the Milestones

Rationale for EBM Curriculum Standardized implementation, acceptance, and success of EBM curricula still lacking in GME Barriers to residents practicing EBM: Access to medical information Skills in searching resources Clinical question tracking Lack of experience, knowledge, and skills in EBM

Rationale for EBM Curriculum Family Medicine residency training critical Next Accreditation System Milestones Changing payment environment Challenges in documenting and assessing residents’ ability to practice cost-effective EBM

Goals of Curricula Strengthen residents’ ability to do the following: Formulate clinical questions Effectively search unbiased resources Critically appraise medical literature Apply findings to patient care

Components of Curricula Formal evidence-based pharmacotherapy (EBP) rotation Required rotation in either the PGY-2 or PGY-3 year of residency training and precepted by Family Medicine Pharmacy faculty Annual workshop series Occurs during residents’ regular didactic time and during Upper Level Orientation for rising PGY-2s and led by the Director of Clinical Investigations

EBP Rotation Structure 4-week rotation organized by specific foci Week 1 and 2: Interpreting medical literature and direct-to-physician advertising Week 3: Practicing cost-effective EBM Week 4: Application of EBM utilizing current patient scenarios in clinical practice Rotation content focuses on interpreting and applying medical literature, direct-to-physician advertising, using unbiased resources to make clinical decisions, and practicing cost-effective EBM.

EBP Rotation Learning Activities Identify medication ad in American Family Physician (AFP) and discuss direct-to-physician advertising Required readings and self-study on statistics and interpreting medical literature via printed resources or online modules followed by active discussion and Q & A Journal club presentations with standardized questions for discussion

EBP Rotation Learning Activities Independently form a searchable clinical question, explore EBM resources, and answer clinical question Required readings and self-study on insurance types and medication coverage (private, Medicaid, Medicare) and available resources for uninsured patients Identify patients and actively discuss how to improve cost-effective, evidence-based patient care  additional clinical questions to investigate

EBP Assessment Formally assesses three milestones (self-assessment and preceptor): PBLI-1 (Evidence-Based Medicine) PBLI-2 (Self-Directed Learning) SBP-1 (Cost Conscious Medical Care) Pre/post test on biostatistics and medication cost/insurance knowledge

EBP Future Directions Resources for interactions with pharmaceutical representatives or MSLs Incorporate another journal club Incorporate a longitudinal self-directed activity New medication class worksheet Interdisciplinary activity with pharmacy students Clinic resource for residents Articles to help guide residents have meaningful interactions with both pharmaceutical representatives and medical science liaisons (MSLs) Journal club – Need more practice and application in week 3 Worksheet – Help stay updated on new medications in an evidence-based manner and compare to other standard therapies, promotes interdisciplinary education, and will help increase clinic resources for other residents

Annual Research Workshop Series: 1 of 3 Parts Focused on EBM “How To” Topics: Identify a topic for research Turn a question into a researchable question Turn a researchable question into a doable study Choose a mentor Navigate the IRB process Part 1: Residency Requirements (Upper Level Orientation) Graduation requirements/expectations Official timeline How to choose a topic and advisor Current FM faculty projects Presentation grading rubric State/regional/national presentation during the PGY-2 or PGY-3 year Part 3: Effective Presentations (Upper Level Orientation) Presentation techniques PowerPoint tips and tricks

Questions or Comments?

References Ross R, Verdieck A. Introducing an Evidence-based Medicine Curriculum into a Family Practice Residency—Is It Effective? Acad Med. 2003;78:412–417. Green ML, Ruff TR. Why Do Residents Fail to Answer Their Clinical Questions? A Qualitative Study of Barriers to Practicing Evidence-Based Medicine. Acad Med. 2005;80:176–182. Allan GM, Korownyk C, Tan A, et al. Developing an Integrated Evidence-Based Medicine Curriculum for Family Medicine Residency at the University of Alberta. Acad Med. 2010;85:1163–1170. van Dijk N, Hooft L, Wieringa-de Waard M. What Are the Barriers to Residents’ Practicing Evidence-Based Medicine? A Systematic Review. Acad Med. 2010;85:1163–1170.

Please evaluate this presentation using the conference mobile app Please evaluate this presentation using the conference mobile app! Simply click on the "clipboard" icon on the presentation page.