1. 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

2. Disclosures
Nothing to Disclose

3. 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.

4. 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.

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

6. 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:

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

8. 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

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

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

11. Results

12. Results

13. 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 ( – 31.56)
* note that advanced practice provider residents were excluded because no group existed after the intervention.

14. Summary
Competency in EBM improved significantly. (120.9 vs , 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.

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

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

17. 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

18. Questions?

19. 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