Evidence-Based Medicine Resources for Physician Assistant Faculty: DynaMed

Abstract

INTRODUCTION When we took the first tentative steps years ago to develop a new clinical problem-solving curriculum that embraced the concepts of evidencebased medicine (EBM), there was little we could say to students who asked, “But how are we going to do this in the clinic”? The concepts were sound but the immediate application to patients, the only thing that really matters, was stymied by the lack of useful tools. Fortunately, innovation and technology have progressed rapidly and placed a number of devices in the hands of clinician educators that they can use at the bedside and in the exam room. The computer-based electronic health record (EHR) has become ubiquitous. The dog-eared notebook “peripheral brains” of our generation, loaded with clinical facts and held together by a rubber band, have been replaced by sleek and speedy PDAs with instantly accessible voluminous libraries and databases. Many clinicians have become so dependent on these tools that to suffer a system crash, or even to leave them by accident at home, produces instant anxiety. I (DK) have made a mad dash from clinic back to home to retrieve mine more than a few times. Since purchasing Epocrates, a medication database, I have not looked at a Physicians’ Desk Reference text. I’m not even sure the clinic still has one. PDAs have become a necessity for the majority of PA educator/clinicians; however, the choice of software can be overwhelming and is often made with the gut rather than the head. The decision to purchase Epocrates, for example, was made after a brief exposure through a colleague and a free trial. There was no careful weighing of the pros and cons of other products — and this is probably true of many clinical educators. As a new tool is used, we grow familiar and comfortable with the interface and it becomes literally an extension of our bodies. We tend to stay with the same tools not only because they are good, but also because we don’t want to take time to learn a new system. For instance, we have colleagues who swear by LexiComp, another medication database, but we have no interest in investing time to learn a new tool that would replace one that has already become indispensable. Our students often have technology skills that exceed those of faculty. It is important for faculty to become facile with the available resources to support our students’ evidence-based clinical practice. For this reason, the EBM feature in this journal will occasionally review tools that may assist PA educators with their EBM curriculum and help them make choices in a more systematic way. The focus of this review is a computer and PDA database application called DynaMed, which has been designed from the ground up on the principles of EBM.