1. The appraisal and assimilation of scientific evidence, and its application to patient care: A key competency in the design of the professional curriculum Robert H. Roswell, M.D. Senior Associate Dean and Professor of Medicine, College of Medicine Adjunct Professor of Health Administration and Policy, College of Public Health

2. 2006

3. Can we continue to use a traditional approach to train physicians in view of this growth? NO!

4. ACGME General Competencies Patient Care

5. ACGME General Competencies Patient Care Medical Knowledge

6. ACGME General Competencies Patient Care Medical Knowledge Practice-based Learning and Improvement

7. ACGME General Competencies Patient Care Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills

8. ACGME General Competencies Patient Care Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism

9. ACGME General Competencies Patient Care Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based practice

10. ACGME General Competencies Patient Care Medical Knowledge Practice-based Learning and Improvement Interpersonal and Communication Skills Professionalism Systems-based practice

11. Practice-based Learning and Improvement: required skills Analyze own practice for needed improvements

12. Practice-based Learning and Improvement: required skills Analyze own practice for needed improvements Use of evidence from scientific studies

13. Practice-based Learning and Improvement: required skills Analyze own practice for needed improvements Use of evidence from scientific studies Application of research and statistical methods

14. Practice-based Learning and Improvement: required skills Analyze own practice for needed improvements Use of evidence from scientific studies Application of research and statistical methods Use of information technology

15. Practice-based Learning and Improvement: required skills Analyze own practice for needed improvements Use of evidence from scientific studies Application of research and statistical methods Use of information technology Facilitate learning of others

16. Towards Evidence Based Medicine Access to relevant literature

17. Towards Evidence Based Medicine Access to relevant literature Critical evaluation of quality of evidence

18. Towards Evidence Based Medicine Access to relevant literature Critical evaluation of quality of evidence Meta-analysis

19. Towards Evidence Based Medicine Access to relevant literature Critical evaluation of quality of evidence Meta-analysis Formulation of EBM Guidelines

20. Towards Evidence Based Medicine Access to relevant literature Critical evaluation of quality of evidence Meta-analysis Formulation of EBM Guidelines Incorporation of EBM into Health Information Systems

21. JAMA. 2005;293:1223-1238. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes Amit X. Garg, MD; Neill K. J. Adhikari, MD; Heather McDonald, MSc; M. Patricia Rosas- Arellano, MD, PhD; P. J. Devereaux, MD; Joseph Beyene, PhD; Justina Sam, BHSc; R. Brian Haynes, MD, PhD

22. JAMA. 2005;293:1223-1238. Methods We included English-language randomized and nonrandomized trials with a contemporaneous control group that compared patient care with a CDSS to routine care without a CDSS and evaluated clinical performance (ie, a measure of process of care) or a patient outcome.

23. JAMA. 2005;293:1223-1238. Results From 3997 screened citations, we retrieved 226 full-text articles, and 100 trials met our criteria for review.

24. JAMA. 2005;293:1223-1238. Results Practitioner performance improvement Overall 64% Diagnostic systems 40% Reminder systems 76% Disease management 62% Drug-dosing or prescribing 66%

25. JAMA. 2005;293:1223-1238. Conclusions Many CDSSs improve practitioner performance, however their effects on patient outcomes are less clear.

26. Summary EBM will be essential to successfully manage the continued rapid growth of medical literature

27. Summary EBM will be essential to successfully manage the continued rapid growth of medical literature EBM must be an integral part of physician training

28. Summary EBM will be essential to successfully manage the continued rapid growth of medical literature EBM must be an integral part of physician training EBM offers great promise to improve care delivery and patient outcomes