Resident Educator Development The RED Program A Residents-as-Teachers Curriculum Developed by Heather A. Thompson, MD

The RED Program Team Leadership How to Teach at the Bedside The Microskills Model: Teaching during Oral Presentations How to Teach EBM The Ten Minute Talk Effective Feedback Professionalism Patient Safety and Medical Errors

How to Teach EBM: Search Strategies, Critical Appraisal of an Article, Educational Rx Developed by Brad Benson, MD

EBM in Action Residents often review journal articles with their team as part of their educational activity on the wards. –However, at times we have trouble finding the an appropriate paper that addresses our specific question, and is statistically sound. –And once we find an appropriate article, we need to be able to evaluate that article and determine the strength of the evidence.

EBM in Action This module will specifically address these two issues: –Search Strategies –Critical Appraisal This module will also cover a tool to facilitate EBM on the wards: the Educational Rx.

Useful Search Strategies Clinical question: How do I treat herpes stomatitis in children?

All of the papers on Medline RCTs and SRs and Meta-analyses

Generating Your Own Filters On Ovid Medline

Methodologic Filters Increase Yield and Decrease Search Time!

EBM: Visual Tool For Teaching Critical Appraisal Of The Randomized Controlled Trial

Objectives 1) The learner will draw a flow diagram of a randomized controlled trial and label the five common points where bias or design flaws are found. 2) The learner will recall at least one question at each of the 5 critical points to stimulate discovery of potential biases or problems in the study design.

Objectives 3) The learner will recall the 5 Cs that are sources of potential bias during the follow-up period of a RCT 4) The learner will increase confidence level in the ability critically appraise a randomized controlled trial.

Educational Rx While conducting work rounds or presenting patients, clinical questions will come up time and again. –In a hospitalized medical patient, what is the best strategy for preventing a DVT? –What is the best treatment for preventing contrast-induced nephropathyfluids, n- acetylcysteine, bicarb? –What are the usual admission criteria for community acquired pneumonia?

Educational Rx Set the expectation that these clinical questions will be answered by the team, in the form of the Educational Rx. –Model the behavior early on by writing an Educational Rx for yourself (…you can use one you already know the answer to!) –Set aside time at the end of rounds each day to review Educational Prescriptions from previous days. –Can have the intern or student demonstrate the search strategy used. –Can use the back of the yellow copy of the Rx to give specific feedback.

Why Educational Prescriptions Work Formalizes the learning contract. Increases likelihood of follow up. Is a familiar function for physicians: writing a prescription to fix something (in this case, a knowledge gap!) Demonstrates real life application of EBM. Can be used to evaluate the ACGME competency Practice Based Learning and Improvement.

In Summary You can teach and promote EBM through multiple team activities! –Literature Searches –Critical Appraisal of an Article Together –Educational Prescriptions Use your internet resources! – – Use your medical librarians! –Jim Beattie ( , –Cindy Gruwell ( ,