Critical Appraisal of the Medical Literature CABS Module Spring 2004 John Coverdale MD, FRANZCP Paul Haidet MD, MPH Daniel Hunt MD

Goals Promote evidence-based practice on rotations and in clinical practicePromote evidence-based practice on rotations and in clinical practice Set a pattern for life-long learningSet a pattern for life-long learning Develop skill in applying the medical literature to patient careDevelop skill in applying the medical literature to patient care

Today Deciding on What You’re Looking For: The 4-Part Clinical Question

Team Learning Individual PreparationIndividual Preparation Readiness AssuranceReadiness Assurance –Individual –Team Application ActivitiesApplication Activities

Individual Preparation Please read the article on asking clinical questions now ( approx. 10 minutes)Please read the article on asking clinical questions now ( approx. 10 minutes)

Individual Readiness Assurance Take the Readiness Assurance Test in your folders; record your answers on the answer sheetTake the Readiness Assurance Test in your folders; record your answers on the answer sheet Closed BookClosed Book

Team Readiness Assurance Now, take the SAME TEST again as a teamNow, take the SAME TEST again as a team Use the ‘IF-AT’ forms to record your team’s answersUse the ‘IF-AT’ forms to record your team’s answers

Using the ‘IF-AT’ form Decide with your group which is the correct answer and scratch that answer on the formDecide with your group which is the correct answer and scratch that answer on the form If there is a ‘*’ beneath the answer you scratched, you got the question correct; move on to the next questionIf there is a ‘*’ beneath the answer you scratched, you got the question correct; move on to the next question If there is not a ‘*’, keep scratching until you find the answer with the ‘*’If there is not a ‘*’, keep scratching until you find the answer with the ‘*’ Points will be scored as follows:Points will be scored as follows: –Correct answer on the first scratch: 4 points –Correct answer on the second scratch: 3 points –Correct answer on the third scratch: 1 point –Correct answer on the fourth scratch: 0 points

Application: Decide with your group which of the following questions would be best. A.What are the guidelines for management of diabetic ketoacidosis in pediatric patients? B.Does addition of bicarbonate to standard therapy improve the serum pH in pediatric patients with DKA? C.In a pediatric patient with diabetic ketoacidosis, does the addition of bicarbonate to standard therapy improve mortality? D.In a pediatric patient with newly-diagnosed diabetes mellitus presenting as DKA, is there a physiological rationale for the use of bicarbonate? E.What are the adverse pathophysiological consequences of bicarbonate in diabetic ketoacidosis?

The Four-Part Question PopulationPopulation Intervention (or risk factor)Intervention (or risk factor) Comparison GroupComparison Group Outcome (‘final’ outcomes better)Outcome (‘final’ outcomes better)

Team Learning Individual Preparation (see one)Individual Preparation (see one) Individual Readiness Assurance (do one)Individual Readiness Assurance (do one) Team Readiness Assurance (teach one)Team Readiness Assurance (teach one) Application Activities (collaborate and debate one)Application Activities (collaborate and debate one)

Team Learning Principles There is Strength in numbersThere is Strength in numbers Well-functioning teams do better than their best (smartest) individualWell-functioning teams do better than their best (smartest) individual Grades to both individual and teamGrades to both individual and team

Grade Weights Individual Grade – 40%Individual Grade – 40% –Readiness Assurance –Homework –Final Exam Team Grade – 60%Team Grade – 60% –Readiness Assurance –Final Exam

Next Session Finding What You’re Looking For: Efficient Searching of the Medical Literature Dan Hunt, MD