C. Heneghan and P. Glasziou

Introduction

The process of lifelong, self-directed learning includes recognition of clinically important questions about diagnosis, therapy, prognosis and other aspects of healthcare when caring for our patients. The methods of evidence-based medicine (EBM) aim to provide skills that help clinicians to rapidly answer these questions and assimilate new evidence and ideas and put them into practice.

We can summarize the EBM approach as a four-step process (Straus et al 2005):

To remind us to evaluate and improve our skills at these steps, a fifth step is often suggested: evaluating your own self education performance.

In this chapter we outline a possible curriculum plan for teaching EBM, moving from awareness and principles to skills and practice.

Introductory lecture: an hour on raising awareness

Initial concepts in an introductory lecture should include what EBM (sometimes called ‘evidence-based practice’) is and isn’t, the problem of our information overload, our need to discriminate between good-and-poor quality evidence and how EBM skills can help.

Important themes to develop are trying to keep up to date and the problem of overcoming the increasing world literature: over 1500 new medical research articles are published daily (Fig. 33.1). You might stop and ask your learners to reflect on how they currently learn and keep up to date. You might also ask them how much time is being spent on each process. Activities usually identified include attending lectures and conferences, reading articles in journals, tutorials, textbooks, clinical guidelines, clinical practice, small-group learning, study groups, using electronic resources and speaking to colleagues and specialists. There is no right or wrong way to learn; a mixture of all of these methods will be beneficial in the overall process of gathering information.

It is helpful to think of learning needs as a process of gathering information in two different ways: ‘push’ and ‘pull’. The ‘push’ is learning from the deluge of information that arrives in our post or email, on a variety of topics. This type of learning can be thought of as ‘just-in-case learning’. When the information is filtered to provide only what is important to clinical practice and has already been appraised for certain validity criteria, it can be very useful. But most of our learning should focus on information ‘pull’: answering the questions that arise in practice (also called ‘just-in-time’ learning).

Asking answerable questions

You should consider following or combining this session (1–2 hours) with a searching skills laboratory (1–2 hours). Your librarians may have skills unbeknown to you that might help in this area. Use the PICO principle to formulate the clinical questions:

Learners should practise dissecting the question into its component parts and then restructuring it so that the components can be used to direct the search. Prior to clinical work, scenarios are useful for teaching question building. For the less experienced, you might begin with short scenarios that lend themselves to dissecting the question(s) easily.

One way to begin is by giving an initial patient presentation and asking students what medical knowledge they need to ‘solve’ the clinical problem. List all the questions, and then classify them using the typology below (the type will affect where you look for the answer, and what type of research you can expect to provide it):

Searching for the evidence

Resources which you will need are the following:

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