How to deliver teaching that gets to the P in Evidence Based Practice
May 9, 2019
‘The teaching EBM (TEBM) course was a great experience – working with and helping others develop their teaching skills’
Much of the learning in the TEBM course occurs in small groups; frequently our discussions would turn to the issue of not just teaching EBM knowledge but how to encourage others to adopt Evidence Based Practice. Colleagues from all over the world would describe, at their regular teaching sessions, seminars or journal clubs, how their learners would accept EBM concepts but not translate this into their daily work. This was striking and clearly presents a problem for those of us who teach EBM. We know (from evidence) that to go beyond knowledge transfer to improve skills and attitudes we need to integrate our teaching with clinical practice. But ow can we achieve this?
The definition of Evidence Based Practice was agreed in 2005. Key to the definition is that it’s about those receiving care making decisions, supported by the care givers and the best available evidence. This means focussing our teaching on helping learners develop the skills and attitudes to be able to do this for their patients, in their clinical setting with confidence.
The emphasis throughout TEBM on patient based problems is highlighted in the systematic review of studies of clinically integrated EBM teaching, the common theme was bringing clinicians daily clinically problems to the teaching sessions and then using these to demonstrate the 4 As of EBM. Reflecting on the course has helped me develop this, here are my tips for grounding your teaching in clinical practice.
Ask: it’s much more powerful to use examples from your groups clinical practice than ones you’ve brought along. The closer you can get the session to when those uncertainties arise the better. At the end of a clinic or ward round is ideal, if not email in advance to get the learners to recognise and bring any clinical problem works well. PICO, Patient, Intervention, Comparison, Outcome is a good framework for structuring their questions. Increasingly I challenge the learners to focus on the O, the outcomes that matter for their individual patient.
Acquire: searching skills are important but how can your learners actually do this in practice? We have worked with our information specialists to come up with a table of apps that learners can download to do this on the job (link coming soon). We combine this with what the learners are using already and try them out. They come away with searching skills and tools to do this.
Appraise: How can we best focus this on what matters for the patients? Checking the research paper’s PICO question matches their clinical problem is crucial. What’s the next step? From a patient’s perspective I suspect it’s (even assuming the trial results are valid) are the results clinically meaningful for me? If they are – teach about a critical appraisal tool.
Apply: How can you translate the results of the trial into a form that means something for you and the patient? Challenge learners to think about their understanding of the findings and how they can turn this into something meaningful. Natural frequencies (using 3 in 100 rather than 3%) can help both doctors and patients understanding. If it’s a clinical question that will be asked repeatedly, what decision aids can support this? I like to show an example from my practice, again challenging learners to bring EBM to their daily work.
I’ve described some of my tip for bringing practical clinical examples to the teaching of EBP. There are more examples at www.cebm.net or www.therapeuticseducation.org, better still come and join the TEBM course to think and discuss how this can work in your workplace. Planning your EBM teaching to demonstrate its practical application in the working lives of your students not only makes it more fun and interesting but more importantly, more likely to be adopted into their practice.
Dr Edmund Jack is a GP in Devon, UK and Clinical Champion for Making Sense of Evidence, PenCLAHRC. He taught on the Teaching Evidence Based Medicine (TEBM) course for the first time in 2018 and hopes to return to the next iteration in September 2019.