1. Incorporating Evidence-Based Medicine in the Residency Curriculum
Katelin M. Lisenby, PharmD, BCPS
Catherine P. Scarbrough, MD, FAAFP
Melanie T. Tucker, PhD
Dana G. Carroll, PharmD, BCPS, CDE
University of Alabama Family Medicine Residency

2. Disclosures
We have nothing to disclose

3. Objectives Identify barriers to evidence-based medicine (EBM)
Identify active learning methods
Describe evaluation methods utilized
Identify barriers to residents learning and practicing evidence-based medicine (EBM)
Identify active learning methods to enhance resident utilization, assessment, interpretation, and application of the medical literature for cost-effective, evidence-based, patient care decisions
Describe methods utilized to evaluate the EBM curriculum and resident learning and progress along the Milestones

4. Rationale for EBM Curriculum
Standardized implementation, acceptance, and success of EBM curricula still lacking in GME
Barriers to residents practicing EBM:
Access to medical information
Skills in searching resources
Clinical question tracking
Lack of experience, knowledge, and skills in EBM

5. Rationale for EBM Curriculum
Family Medicine residency training critical
Next Accreditation System
Milestones
Changing payment environment
Challenges in documenting and assessing residents’ ability to practice cost-effective EBM

6. Goals of Curricula Strengthen residents’ ability to do the following:
Formulate clinical questions
Effectively search unbiased resources
Critically appraise medical literature
Apply findings to patient care

7. Components of Curricula
Formal evidence-based pharmacotherapy (EBP) rotation
Required rotation in either the PGY-2 or PGY-3 year of residency training and precepted by Family Medicine Pharmacy faculty
Annual workshop series
Occurs during residents’ regular didactic time and during Upper Level Orientation for rising PGY-2s and led by the Director of Clinical Investigations

8. EBP Rotation Structure
4-week rotation organized by specific foci
Week 1 and 2: Interpreting medical literature and direct-to-physician advertising
Week 3: Practicing cost-effective EBM
Week 4: Application of EBM utilizing current patient scenarios in clinical practice
Rotation content focuses on interpreting and applying medical literature, direct-to-physician advertising, using unbiased resources to make clinical decisions, and practicing cost-effective EBM.

9. EBP Rotation Learning Activities
Identify medication ad in American Family Physician (AFP) and discuss direct-to-physician advertising
Required readings and self-study on statistics and interpreting medical literature via printed resources or online modules followed by active discussion and Q & A
Journal club presentations with standardized questions for discussion

10. EBP Rotation Learning Activities
Independently form a searchable clinical question, explore EBM resources, and answer clinical question
Required readings and self-study on insurance types and medication coverage (private, Medicaid, Medicare) and available resources for uninsured patients
Identify patients and actively discuss how to improve cost-effective, evidence-based patient care  additional clinical questions to investigate

11. EBP Assessment
Formally assesses three milestones (self-assessment and preceptor):
PBLI-1 (Evidence-Based Medicine)
PBLI-2 (Self-Directed Learning)
SBP-1 (Cost Conscious Medical Care)
Pre/post test on biostatistics and medication cost/insurance knowledge

12. EBP Future Directions
Resources for interactions with pharmaceutical representatives or MSLs
Incorporate another journal club
Incorporate a longitudinal self-directed activity
New medication class worksheet
Interdisciplinary activity with pharmacy students
Clinic resource for residents
Articles to help guide residents have meaningful interactions with both pharmaceutical representatives and medical science liaisons (MSLs)
Journal club – Need more practice and application in week 3
Worksheet – Help stay updated on new medications in an evidence-based manner and compare to other standard therapies, promotes interdisciplinary education, and will help increase clinic resources for other residents

13. Annual Research Workshop Series: 1 of 3 Parts Focused on EBM
“How To” Topics:
Identify a topic for research
Turn a question into a researchable question
Turn a researchable question into a doable study
Choose a mentor
Navigate the IRB process
Part 1: Residency Requirements (Upper Level Orientation)
Graduation requirements/expectations
Official timeline
How to choose a topic and advisor
Current FM faculty projects
Presentation grading rubric
State/regional/national presentation during the PGY-2 or PGY-3 year
Part 3: Effective Presentations (Upper Level Orientation)
Presentation techniques
PowerPoint tips and tricks

14. Questions or Comments?

15. References
Ross R, Verdieck A. Introducing an Evidence-based Medicine Curriculum into a Family Practice Residency—Is It Effective? Acad Med. 2003;78:412–417.
Green ML, Ruff TR. Why Do Residents Fail to Answer Their Clinical Questions? A Qualitative Study of Barriers to Practicing Evidence-Based Medicine. Acad Med. 2005;80:176–182.
Allan GM, Korownyk C, Tan A, et al. Developing an Integrated Evidence-Based Medicine Curriculum for Family Medicine Residency at the University of Alberta. Acad Med. 2010;85:1163–1170.
van Dijk N, Hooft L, Wieringa-de Waard M. What Are the Barriers to Residents’ Practicing Evidence-Based Medicine? A Systematic Review. Acad Med. 2010;85:1163–1170.

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