1. Evidence-Based Medicine: A Foundation and Partnership for EBBM Jason M. Satterfield, Ph.D. Associate Professor Director, Behavioral Medicine Div of Gen Internal Medicine

2. Emergence of Evidence- Based Medicine 1910 Flexner report 1972 Archie Cochrane – Effectiveness and Efficiency 1972 RWJ Clinical Scholars Program 1982 Clinical Epidemiology (McMaster U) Clinical decision theory 1984 American College of Medical Informatics 1990 “Scientific medicine” and Evidence- based medicine 1992-3 Cochrane Collaboration

3. The 5 Step EBM Model n Formulate the question n Search for answers n Appraise the evidence n Apply the results n Assess the outcome

4. “Evidence-Based Capitulation” n Practicing clinicians are too busy to use all EBM steps will all patients n Increased focus on pithy clinical practice guidelines, synopses, and structured abstracts u ACP Journal Club u Cochrane database u “Up-to-date”

5. Pedagogy: How is EBM Taught? n Teaching EBP is about teaching a process – not just what tx have empirical support Journal clubs n Preceptorships/clinical supervision n Embedded throughout a curriculum n Role models demonstrate daily application

6. EBM: Top Lessons Learned n Buy-in from key stakeholders is essential for local adoption and national dissemination n EBM is a lifelong learning skill and not memorization of tx guidelines n Teaching should use active clinical cases with opportunities for practice and revision n The roles of clinical experience and patient values need to be emphasized often and integrated with best evidence

7. Mistakes when teaching EBM n Teaching EBM fails: u When learning how to do research is emphasised over how to use it u When learning how to do statistics is emphasised over how to interpret them u When teaching EBM is limited to finding flaws in published research u When teaching portrays EBM as substituting research evidence for, rather than adding it to clinical expertise, patient values and circumstances