Guided Mentorship in Evidence-Based Medicine for Psychiatry: A Pilot Cohort Study Supporting a Promising Method of Real-Time Clinical Instruction

Abstract

Evidence-based medicine has been promoted to enhance clinical decision making and outcomes in psychiatry. Residency training programs do not routinely provide instruction in evidence-based medicine. Where instruction exists, it tends to occur in classroom settings divorced from the clinical decision-making process and is focused narrowly on appraisal of evidence quality. The goal of this pilot study was to develop and evaluate the promise of a method of "hands-on" instruction in evidence-based medicine done in real clinical time. A modularized curriculum to promote decisionmaking strategies using evidence-based medicine during the course of actual patient care was delivered by an attending physician mentoring a small team on the inpatient and consultation-liaison psychiatry services at Stanford. A staggered cohort of 24 consecutive trainees was followed between August and January 2007. Measures of trainees' skills in evidence-based medicine were assessed before and after mentoring. A blinded grader scored each inventory according to an explicit, predefined rubric. Demonstrated proficiency in delivery in each of the core skills of evidence-based medicine was assessed as a secondary outcome measure via the attending physician's unblinded subjective evaluation of trainee performance. Subjective descriptions of the experience were obtained via review of trainees' evaluations. Postmeasures of knowledge and skills in evidence-based medicine increased significantly relative to baseline. The Cohen's d effect size was large and clinically meaningful. The majority of trainees were able to demonstrate adequate proficiency of skills by attending subjective evaluation. Trainees' subjective experiences overall were positive. Guided mentoring in evidence-based medicine appears promising for further study.