Educational Perspectives

Abstract

The rapid pace at which medical knowledge is advancing presents a daunting challenge for practicing physicians, including those involved in medical education. Within this field, practicing and teaching evidence-based medicine (EBM) has become an instrumental approach to modeling and teaching the skills involved in searching, reading, interpreting, and using the medical literature to improve patient care. David Sackett has defined EBM as “the integration of individual clinical expertise with the best available external clinical evidence.” (1) The general principles of EBM, including the five steps of practicing EBM (Table 1), recently were reviewed in this journal by Polin and colleagues. (2) | 1. Formulate answerable clinical questions. 2. Search the literature efficiently and effectively. 3. Critically appraise the evidence. 4. Apply valid evidence into clinical decision-making. 5. Evaluate one's own performance. | || Table 1. The Five Steps of the Evidence-based Medicine Process In 1999, the Accreditation Council of Graduate Medical Education defined six core competencies that must be developed during residency and fellowship training (Table 2). The competency of practice-based learning is defined as “[practice] that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care.” (3) This definition is remarkably similar to Sackett's definition of EBM, and, in fact, the development of EBM curricula has become one of the methods by which training programs are addressing practice-based learning competency. These curricula include journal clubs, didactic and interactive EBM seminars, and less commonly, clinically integrated formats. A recent systematic review evaluating the effects of stand-alone versus clinically integrated teaching in EBM on postgraduate learners' knowledge, critical appraisal skills, attitudes, and behavior revealed improvement only in knowledge with the stand-alone curricula; integrated approaches resulted in measurable improvements in all four outcome measures. (4) | Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health | || | Medical Knowledge about established and evolving biomedical, clinical, and cognate (eg, epidemiological and social-behavioral) sciences and the application of this knowledge to patient care | | Practice-based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care | | Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals | | Professionalism , as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population | | Systems-based Practice , as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value | * Used with permission, Accreditation Council of Graduate Medical Education, Chicago, Ill. (www.acgme.org) Table 2. ACGME General …