2. “Look-up Conference” A Learner-driven Resident Conference Format Timothy N. Stephens, MD Allen F. Shaughnessy, PharmD Tufts University Family Medicine Residency STFM 41 st Annual Spring Meeting May 1, 2008

3. Goals & Objectives Participants will be able to:  Convert a clinical question into an answerable format using the PICO format  List 3 different point-of-care ‘hunting’ tools (evidence review sources) for finding answers to clinical questions  Implement a resident conference to develop these skills into a continuing education strategy for residency graduates

4. Goals & Objectives  ‘Good’ clinical questions  Taking time to look for evidence rather than relying on ___  Your own personal learning / Information Mastery system

5. Discussion: Describe your current system for information-gathering

6. PICO Format: Asking “good” clinical questions

7. PICO Format  Patient or population  Intervention  Comparison  Outcome  Example: Choosing a medication for a 44 yo M with painful diabetic neuropathy

8. Drilling for the Best Information Cochrane Library EB Practice Guideline Specialty-specific POEMs Best Evidence Clinical Evidence Clinical Inquiries Textbooks, Up-to- Date, 5-Minute Clinical Consult Usefulness Medline

9. Information Sources for the Point of Care Keep in mind the usefulness equation: Usefulness = Relevance x Validity Work

10. Levels of Evidence (LOE) Centre for Evidence-Based Medicine (Oxford) Expert Opinion: LOE = 5 Case Series: LOE = 4 Case Control: LOE = 3b RCT: LOE = 1b Systematic Review with homogeneity LOE = 1a http://www.cebm.net/levels_of_evidence.asp

11. Highly Controlled Research  Randomized Controlled Trials  Systematic Reviews Physiologic Research Preliminary Clinical Research  Case reports  Observational studies Uncontrolled Observations & Conjecture Effect on Patient-Oriented Outcomes  Symptoms  Functioning  Quality of Life  Lifespan Effect on Disease Markers  Diabetes  Arthritis  Peptic Ulcer Effect on Risk Factors for Disease  Improvement in markers (blood pressure, cholesterol) Valid Patient- Oriented Evidence Validity of Evidence Relevance of Outcome

12. Strength of Recommendation Taxonomy (SORT) A. Consistent and good-quality POE Standard LOEs for validity, POE vs DOE for relevance B. Inconsistent or limited-quality POE C. Consensus, usual care, opinion, DOE, case series

13. Highly Controlled Research  Randomized Controlled Trials  Systematic Reviews Physiologic Research Preliminary Clinical Research  Case reports  Observational studies Uncontrolled Observations & Conjecture Effect on Patient-Oriented Outcomes  Symptoms  Functioning  Quality of Life  Lifespan Effect on Disease Markers  Diabetes  Arthritis  Peptic Ulcer Effect on Risk Factors for Disease  Improvement in markers (blood pressure, cholesterol) SORT A Validity of Evidence Relevance of Outcome SORT B SORT C

14. Group Exercise: Look-up Conference Simulation

15. PICO Format  Patient or population  Intervention  Comparison  Outcome  Example: Choosing a medication for a 44 yo M with painful diabetic neuropathy

16. PICO Question  PIn patients with painful peripheral neuropathy due to diabetes  IWhat treatments are more effective than  CPlacebo or no treatment  OIn decreasing patient reports of pain and disability?

17. www.TRIPdatabase.com

20. www.DynamicMedical.com

25. www.EssentialEvidencePlus.com

28. Recap: Goals & Objectives Participants will be able to:  Convert a clinical question into an answerable format using the PICO format  List 3 different point-of-care ‘hunting’ tools (evidence review sources) for finding answers to clinical questions  Implement a resident conference to develop these skills into a continuing education strategy for residency graduates

29. Discussion / Questions