1. The Problem Health Care Providers are seeing an increased number of patients with more complex problems. Health Care Providers are seeing an increased number of patients with more complex problems. The number of treatment options and medication choices are also increasing. The number of treatment options and medication choices are also increasing. The volume of literature discussing these options is increasing. The volume of literature discussing these options is increasing. Health Care Providers are having difficulty keeping up-to-date with modern approaches to medicine. Health Care Providers are having difficulty keeping up-to-date with modern approaches to medicine.

2. The Solution Evidence Based Medicine utilizes the current best evidence in the form of clinical research to make decisions about the care of individual patients. Evidence Based Medicine utilizes the current best evidence in the form of clinical research to make decisions about the care of individual patients. EBM consists of six main parts: EBM consists of six main parts: See a patient See a patient Ask a clinical question Ask a clinical question Seek the best evidence for that question Seek the best evidence for that question Evaluate the evidence Evaluate the evidence Apply the evidence Apply the evidence Monitor the effect of the evidence Monitor the effect of the evidence

3. The EPOC Project The EPOC project will provide physicians with the skills needed to obtain high quality evidence at the point of care. The EPOC project will provide physicians with the skills needed to obtain high quality evidence at the point of care. Done through education on the importance of EBM and the process of finding information. Done through education on the importance of EBM and the process of finding information. The goal of the EPOC project is to implement EBM practices in all areas of the hospital. The goal of the EPOC project is to implement EBM practices in all areas of the hospital. My Role My Role Collect data from the OB/GYN residency to see where residents currently stand on the use of EBM Collect data from the OB/GYN residency to see where residents currently stand on the use of EBM

4. Collecting Data Shadowed OB/GYN residents in both inpatient (Perinatal Unit) and outpatient (Center for Womens Medicine) settings Shadowed OB/GYN residents in both inpatient (Perinatal Unit) and outpatient (Center for Womens Medicine) settings Documented any clinical questions that arose, including type of question (Treatment, Diagnostic, Harm/Risk, or Prognosis) Documented any clinical questions that arose, including type of question (Treatment, Diagnostic, Harm/Risk, or Prognosis) Recorded resources, if any, used to answer questions and the Level of Evidence of source Recorded resources, if any, used to answer questions and the Level of Evidence of source Documented the answers found Documented the answers found

5. Collecting and Entering Data Recorded whether answer influenced the care provided or the decision making process Recorded whether answer influenced the care provided or the decision making process Determined whether the answers were POEMs (Patient Oriented Evidence that Matters) or DOEs (Disease Oriented Evidence) Determined whether the answers were POEMs (Patient Oriented Evidence that Matters) or DOEs (Disease Oriented Evidence) Entered all data into a Microsoft Access Database Entered all data into a Microsoft Access Database Used Database to run queries and reports of data Used Database to run queries and reports of data

6. Analyzing Data Researched clinical questions to see if a better answer could be found from an evidentiary perspective. Researched clinical questions to see if a better answer could be found from an evidentiary perspective. Used online databases such as: Used online databases such as: SUM Search SUM Search TRIP Database TRIP Database Info Retriever Info Retriever Developed a general search strategy using OB/GYN portal page on www.myhq.com Developed a general search strategy using OB/GYN portal page on www.myhq.com Dynamed PubMed

7. An Example A 27 year old patient at 30 weeks pregnant presents with pre- term premature rupture of membranes. What is the best method of treatment: induction or expectant management? A 27 year old patient at 30 weeks pregnant presents with pre- term premature rupture of membranes. What is the best method of treatment: induction or expectant management? I entered PROM into SUM Search I entered PROM into SUM Search Results: Results: ACOG Practice Bulletin ACOG Practice Bulletin Recommends induction if at term. If pre-term, expectant management should be pursued with the use of antibiotics prior to 35 weeks gestation. Recommends induction if at term. If pre-term, expectant management should be pursued with the use of antibiotics prior to 35 weeks gestation. Preterm Premature Rupture of membranes: Is there an optimal age for delivery? Expectant management of women at 34 weeks and beyond is of limited benefit. Preterm Premature Rupture of membranes: Is there an optimal age for delivery? Expectant management of women at 34 weeks and beyond is of limited benefit.

8. General Results 112 patients seen (39 Inpatient, 73 Outpatient) 112 patients seen (39 Inpatient, 73 Outpatient) 127 clinical questions recorded (25 related to inpatients, 101 related to outpatients) 127 clinical questions recorded (25 related to inpatients, 101 related to outpatients) Question Types: Question Types:

9. General Trends 70% of answers influenced the care given to patients 70% of answers influenced the care given to patients 91% of the questions were answered only by an educational influence (attending physician) 91% of the questions were answered only by an educational influence (attending physician) Most common types of questions: Most common types of questions: Timing for treatment (induction, ultrasounds, etc) Timing for treatment (induction, ultrasounds, etc) Uses and risks of medication Uses and risks of medication Many clinical questions were not framed in a way that could utilize EBM. Many clinical questions were not framed in a way that could utilize EBM.

10. Conclusions Most residents do not utilize EBM procedures. Most residents do not utilize EBM procedures. Instead, residents rely on attending physicians to answer all clinically related questions. Instead, residents rely on attending physicians to answer all clinically related questions. Many times, better answers can be found using current medical literature. Many times, better answers can be found using current medical literature. Better answers lead to better patient care. Better answers lead to better patient care. Thus, if we want to improve patient care, we must teach doctors how to find and implement the best evidence available. Thus, if we want to improve patient care, we must teach doctors how to find and implement the best evidence available.

11. The Next Step Through the course of the year, residents will be taught how to find current evidence to answer clinical questions. Through the course of the year, residents will be taught how to find current evidence to answer clinical questions. Residents will be monitored to see if they have implemented EBM strategies. Residents will be monitored to see if they have implemented EBM strategies. Project will spread into other departments in the hospital. Project will spread into other departments in the hospital.

12. My Experience Additional Opportunities Additional Opportunities Observed Neurosurgery Observed Neurosurgery Visited Cardiac Cath Lab Visited Cardiac Cath Lab Rounded with NICU team Rounded with NICU team What Ive Learned About What Ive Learned About The atmosphere of a hospital The atmosphere of a hospital The complexity of being a physician The complexity of being a physician