Evidence Based Medicine Worth Spreading Christopher R. Carpenter, MD, FACEP, FAAEM Great Plains SAEM Regional Meeting September 28, 2013

It takes 17 years to turn 14 per cent of original research 18% variable Negative results Dickersin, 1987 Submission 46% 0.5 year Kumar, 1992 Koren, 1989 Acceptance Negative results 0.6 year Kumar, 1992 Publication It takes 17 years to turn 14 per cent of original research to the benefit of patient care 35% 0.3 year Poyer, 1982 Balas, 1995 Lack of numbers Bibliographic databases 50% 6. 0 - 13.0 years Antman, 1992 Poynard, 1985 Reviews, guidelines, textbook 9.3 years Inconsistent indexing Implementation E.A. Balas, 2000

CORD survey of 157 conference attendees with 98 faculty respondents (62% response rate) 75% reported no formal EBM curriculum or Journal Club 71% do not use structured critical appraisal forms to analyze manuscripts

EM faculty EBM expertise expectations differ A “successful” EBM curriculum during EM residency will ensure that learners can Identify flawed research (45%) Apply research findings to patient care (43%) Comprehend research methods (33%) EM faculty EBM expertise expectations differ Critical appraisal proficiency (63% high or very high) Access/use secondary peer review sources (88% agree or strongly agree)

Characteristics of Suboptimal Journal Club/EBM Curricula Lack of a single faculty leader Suboptimal manuscript selection Failure to use critical appraisal forms No archiving of results Research nihilism Statistical uncertainty Insufficient individualized feedback Failure to translate findings to bedside From “Teaching Lifelong Learning Skills” in Practical Teaching in Emergency Medicine, 2nd Edition, 2012

Easy to find website via Google search for “emergency medicine journal club”. Can also join monthly e-mail stream or on Twitter. Rated the #1 FOAMed website by the Skeptics Guide to Emergency Medicine. http://tinyurl.com/WashU-EMJournalClub

The website also includes a “toolbox” of useful links to other EBM resources to assist learners and EBM practitioners. http://tinyurl.com/WashU-EMJournalClub

BEEM Best Evidence in Emergency Medicine http://tinyurl.com/WhatIsBEEM YOU! the 10-20 EM articles are sent to over 100 BEEM raters. These are front line emergency doctors just like you. Raters are asked to assume that the results of this article are valid. They are then asked to rate clinically how important the paper is to their own practice. Again, many articles to not make it past this stage. Only those highly rated papers are appraised by BEEM faculty Standardized EBM tools are used to create a critical appraisal and BEEM bottom line. These critical reviews are then provided to you so you can provide your patients with the BEST care.

Acad Emerg Med 2011; 18: 1193-1200 Acad Emerg Med 2013 (in press)

BEEM is Global BEEM is Global. It has presented its high quality, clinically relevant information around the world including: - Australia, Europe, Middle East, Caribbean, Mexico and USA.

Skeptics Guide to Emergency Medicine: www.TheSGEM.com KT/Dissemination Project 44 podcasts on iTunes 1,200 registered to blog 700 twitter followers Turning MedEd on its Head FOAMed Car is the Classroom The SGEM: Meet ‘em, greet ‘em, treat ‘em and street ‘em. First rule of emergency medicine...Don’t panic, All bleeding stops, eventually Turning medEd on its head and trying to shorten the KT window form 10 years down to 1 Part of the FOAMed movement (Free Open Access to Medical Education) Uses social media (weekly podcast, twitter/Facebook, blog and youtube videos) Turn your car into a classroom The Medium is the Message Be skeptical of anything you learn, even if you heard it on The Skeptics Guide to Emergency Medicine "The medium is the message." Marshal McLuhan

Meet at 12PM on May 15 in Tower Room 1403 http://tinyurl.com/cfse6ko

Resources Twitter http://tinyurl.com/WashU-EMJournalClub http://tinyurl.com/WhatIsBEEM www.TheSGEM.com Twitter Wash U JC: @emjclub SAEM EBM: @saemebm SGEM: @TheSGEM E-mail: carpenterc@wusm.wustl.edu