Department of Emergency Medicine A Dedicated Evidence-Based Medicine Curriculum as part of Journal Club Improves Resident Performance in Interpreting Medical Literature Nicholas M. Mohr, Andrew J. Stoltze, Azeemuddin Ahmed, Jon N. Van Heukelom, Christopher P. Hogrefe, Karisa K. Harland. Department of Emergency Medicine University of Iowa

Disclosures Nothing to Disclose

ACGME Emergency Medicine Program EBM Requirements Most recent requirements July 1, 2013. Residents are expected to develop skills and habits to be able to meet the following goals: locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems; (IV.A.5.d).(6) use information technology to optimize learning; (IV.A.5.d).(7) apply knowledge of study design and statistical methods to critically appraise the medical literature; (IV.A.5.d).(9) use information technology to improve patient care (IV.A.5.d).(10) ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. 7/1/2013.

Expectations of EBM Curricula: 2010 CORD Survey 75% reported no established EBM curriculum for journal club. 71% reported no critical appraisal instrument. Carpenter CR et al. Academic Emergency Medicine 2010; 17:S54-S61.

Expectations of EBM Curricula: 2010 CORD Survey (continued) Carpenter CR et al. Academic Emergency Medicine 2010; 17:S54-S61.

The Fresno Test What it is: Why use it: Series of open-ended questions. Standardized grading rubric. Measures knowledge and skills necessary for EBM practice. Why use it: Excellent inter-rater reliability, internal consistency, and item discrimination. Construct validity established. Ramos KD et. al. BMJ. 2003; 326:319-21.

Objectives Implement a novel dedicated curriculum in EBM. Measure its effectiveness in improving EBM competence using a validated instrument (the Fresno test).

Methods: Curriculum Methodology Lectures Dedicated Faculty Group Lecture Topics: Introduction & PICO Question Identifying an Article Levels of Evidence Gold Standard Study Validity CPC Competition Bias P-Values, Alpha Sensitivity, Specificity, PPV, NPV Number Needed to Treat Absolute and Relative Risk Reduction Meta-analysis and Cochrane Dedicated Faculty Group Methodology Lectures Resident-Guided Critique Article Selection to Support Methodology Topic

Methods: Measurement Fresno test before and after curriculum. Generalized Estimating Equations. Account for repeated measures. Adjust for year in residency.

Results Majority of trainees completed the test in the pre-intervention (88%, n = 22) and post-intervention groups (92%, n = 23).

Results

Results

GEE Model Factor Beta p Year (pre-intervention referent) 14.55 (1.73 – 27.37) 0.026 R1 Referent 0.419 R2 11.16 (-7.04 – 29.36) R3 10.58 (-10.40 – 31.56) * note that advanced practice provider residents were excluded because no group existed after the intervention.

Summary Competency in EBM improved significantly. (120.9 vs. 105.4, p = 0.026). Improvement in evaluation of study validity was significant. (40.4 vs. 32.1, p = 0.034). Not associated with performance: Attendance at journal club. Year in residency.

Limitations No control group. Single program. Small number of participants. Multiple administrations of instrument.

Conclusions A novel, dedicated EBM curriculum implemented through resident journal club significantly improves EBM competency.

Acknowledgements Nicholas M. Mohr, MD Azeemuddin Ahmed, MD, MBA Jon N. Van Heukelom, MD Christopher P. Hogrefe, MD Karisa K. Harland, MPH, PhD Department of Emergency Medicine, University of Iowa

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Department of Emergency Medicine A Dedicated Evidence-Based Medicine Curriculum as part of Journal Club Improves Resident Performance in Interpreting Medical Literature Nicholas M. Mohr, Andrew J. Stoltze, Azeemuddin Ahmed, Jon N. Van Heukelom, Christopher P. Hogrefe, Karisa K. Harland. Department of Emergency Medicine University of Iowa