From McGraw-Hill Medical Presented by: Linh Ngu & John Obligacion Evidence-Based Clinical Practice: Online Resources to Teach, Learn, and Apply From McGraw-Hill Medical Presented by: Linh Ngu & John Obligacion

Agenda Fundamentals of evidence-based medicine/practice (EBM/EBP) Importance of EBM for patient care EBM and Resources in the Hospital Sources of Medical Literature

Fundamentals of Evidence-Based Medicine Awareness and understanding of clinical research evidence (i.e. medical literature) Ensuring that the evidence being consulted is trustworthy and grounded in best practice Creating various management strategies that consider patient’s unique predicament, values, and preferences These are the key elements that should be known about EBM: Users need to fully understand the medical literature being referenced. Be able to interpret the readings. Compare the readings Not all evidence is equal. Is the source trustworthy? Is it grounded in best practice? Consider the patient’s unique situation, values, and preferences. What is the best treatment based on these conditions?

Importance of EBM in Patient Care Clinicians gain understanding of patient’s personal circumstances Improves patient adherence to treatment Treatment decisions that are consistent with principles guiding evidence-based practice EBM has become essential in patience care: Forces clinicians to understand the patient’s personal circumstances and get to know the patient When patients can select their treatment option, it improves adherence to the treatment Patients receive treatment that is consistent with principles guiding EBP. Overall, this leads to better outcomes and care

EBM in the Hospital Many clinicians need to be taught how to read, criticize, and apply medical literature When they are not able to make a reasonable criticism on their readings, they rely on reviews. Reviews generally provide biased results One of the main barriers to implementing EBM in organizations is education. Many clinicians need to be taught how to read, criticize, and apply medical literature. If they are not able to make reasonable criticisms and comparisons within their research, they start to rely on reviews. Reviews generally provide biased results. Clinicians need to get into the habit of consulting more than one medical literature source.

Tools in the Hospital How can clinicians acquire the necessary skills for optimal evidence-based practice? What EBM resources are available for them to find answers? There are a couple of things that organizations can do to help their clinicians with EBP: Provide tools to educate their clinicians on EBP. Some organizations may have a course that teaches EBP. Additionally, there are also learning materials available to guide them through the process. Secondly, most organizations purchase content that fulfills the different levels of the evidence hierarchy. Journals, databases, systematic reviews, etc.

JAMAevidence from McGraw-Hill and JAMA An online resource that provides the tools needed for learning, teaching, and applying evidence-based medicine for: Clinicians Researchers Health Professionals Students Residents With the goal of educating clinicians about EBM, McGraw-Hill has partnered with JAMA to create JAMAevidence, an online resource that provides tools needed for learning, teaching, and applying EBM. This is a great resource not only for clinicians, but also researchers, health professionals, students, and residents.

Content from Leading EBM Texts Users’ Guides to the Medical Literature 3rd ed (Guyatt) Foundations through to moving evidence into action The Rational Clinical Examination (Simel) Case-based approach to topics of interest with accompanying teaching/learning slides Correct way to learn medical history and physical examination Care at the Close of Life (McPhee) Addresses issues in palliative care Integrates support as part of the trajectory of care The site provides access to these three leading textbooks in EBM. First and foremost, we have the Users’ Guide to Medical Literature. The lead author is Gordon Guyatt, from McMaster University. It started as the Users’ Guides Series in JAMA in the 1980s. They eventually were stitched together to form this book in 1993. Throughout the years have been updated for clinical relevance and best practice. The book starts with foundations and takes the users through moving to evidence into action. Partnered with the Users’ Guide is The Rational Clinical Examination by lead authors David Simel from Duke and Drummond Rennie from UCSF. This is a case book featuring topics of interest with accompanying slides for teaching and learning. It provides a careful systematic approach to assess the accuracy of the patients medical history and clinical examination Finally, Care at the Close of Life by lead authors Stephen McPhee and team out of UCSF focuses on the softer side of medicine. It addresses issues in palliative care and integrates support as part of the trajectory of care

Online-Only Material Education Guides Downloadable slides to help teach/learn core concepts from the texts JAMAevidence provides online-only material that users would not have access to if they purchased the print book. This includes education guides – downloadable slides to help teach/learn core concepts from the textbooks

Online-Only Material Calculators Enhance the user’s understanding of statistical and mathematical relationships in EBM Estimate risk reduction, harm, and diagnostic values Calculators help users understand statistical and mathematical relationships in EBM. They can estimate risk reduction, harm, and diagnostic values

Online-Only Material Learning Tools Help users synthesize information from their readings Learning tools such as critical appraisal worksheets and information cycle worksheets help users synthesize the information from their readings

Online-Only Material Podcasts Listen to leaders in EBM discuss core issues Recorded and produced by JAMA editors for JAMAevidence Updated monthly The JAMA editors produce podcasts specifically to be posted on JAMAevidence. Users can listen to leaders in EBM discuss core issues each month

What are the EBM Resources? Summaries and Guidelines Online summaries at a topic level Databases of clinical practice guidelines Preappraised research Synopses of systematic reviews (e.g. 1-page summaries) Systematic reviews Synopses of studies (e.g. expert commentary, McMasterPlus, etc) Nonpreappraised research Filtered studies (e.g. MEDLINE) Unfiltered studies (e.g. clinical queries in PubMed) Federated searches All layers of resources searched at once So we’ve shown you a resource that can help users become educated in EBM. The next step is to look at what types of medical literature is available to them. These resources are listed on this slide based on the hierarchy of evidence, starting at the highest level: Summaries and Guidelines – point-of-care reference summaries, clinical practice guidelines (e.g. National Guideline Clearinghouse) Preappraised research – 1-page summaries, systematic reviews, expert commentary Nonpreappraised research – filtered studies, unfiltered studies (e.g. clinical queries) Federated searches – search across the entire hierarchy of evidence at one time. (e.g. TRIP database)

EBM Resources from McGraw-Hill These are EBM resources from McGraw-Hill. This slide features our Access suite of products with the flagship being AccessMedicine, which provides content across many medical specialties. Specialty-specific Access products are also available. Furthermore, there is McGraw-Hill’s point-of-care question and answer database called ClinicalAccess, that users can search to get a quick answer to their clinical queries.

AccessMedicine & ClinicalAccess 80+ Premier textbooks updated online before new editions publish to ensure clinically relevant and current content 2-minute Medicine Summaries of high-impact and current medical literature Access to McMaster Premium Literature Service Search current, scientifically-relevant clinical evidence AccessMedicine and ClinicalAccess can help users with their medical literature research. AccessMedicine features more than 80 premier textbooks, many of which are updated online before new editions are published to ensure content is current and clinical relevant We also recently introduced 2-minute medicine to AccessMedicine. This content has been licensed to provide users with concise, curated, and authoritative medical reports of breaking medical literature. Reports come out daily ClinicalAccess allows clinicians to use the McMaster Premium Literature Service called McMaster Plus. Users can search current, scientifically-relevant clinical evidence that has been rated by the McMaster Online Rating of Evidence (MORE) system

Summary EBM is a rigorous process that requires fundamental understanding and practice. Consider what resources are needed in your organization to teach, learn, and apply EBM

Questions? John Obligacion California (south of Fresno), Arizona, Nevada, New Mexico Email: john.obligacion@mheducation.com Phone: 818-800-6513 Linh Ngu California (Fresno and north) Alaska, Colorado, Idaho, Montana, Oregon, Utah, Washington, Wyoming Email: linh.ngu@mheducation.com Phone: 949-423-7953