171 Ashley Ave.
Charleston, SC 29425
843-792-1414
800-424-MUSC
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July 2006
Feature Story
The Evidence-based Medicine Program: Safety, quality and life-long learning in action
In an exciting, cutting-edge program initiated last year, interns in the pediatric department have been actively learning to put evidence-based medicine (EBM) practices into action.
"This integrated EBM program is the offspring of Dr. Lyndon Key's vision to make EBM a part the culture of the department of pediatrics," explains Dr. Gautham Suresh, leader of the EBM team for pediatrics. "Very few pediatric departments in the country have such a program. It's intensive, and it's on the forefront."
It's a hands-on teaching program in which interns generate clinical questions based on their experience, explains Dr. Suresh.
The new EBM program divided the intern group, including the two Med/Peds residents, into three groups that were mentored by Dr. Suresh and two other faculty members, Ron Teufel, MD, and Joel Cochran, MD. The team also includes reference librarian Laura Cousineau, MLS, who provided initial training and practical experience in the approaches and methods of EBM.
"We're teaching these interns to look for the best evidence available to answer a given question," says Cousineau. "There are two objectives in this program. The first is to provide evidence-based patient care. Secondly, to teach new doctors to make EBM a routine part of patient care, a lifelong process."
This supervised "on-the job" use of EBM practices will develop skills to improve patient care throughout these interns' careers.
"The interns address common real-world questions such as, 'In treating fever in children, is using ibuprofen (Motrin) and alternating it with acetaminophen better than using acetaminophen alone?'" says Dr. Suresh.
"What's the right answer?" he continues. "Ask 20 doctors, and you'll get 14 different opinions. It's well known that there is a big gap between research literature and actual practice. We are teaching these future doctors that the only way to answer these types of questions is to look at the research published. They search for literature, and we help them analyze it and come up with answers to their questions."
There are two stumbling blocks for doctors aiming to practice EBM. "The challenges are formulating a proper question and then, once it's formulated, the most effective way to search for an answer," says Cousineau. "That's why, as a librarian, I'm involved. Once the interns formulate a clinical question, they then need to know how to find an answer, what resources to search."
The program teaches interns to find answers to their questions in as little as 15 minutes. "It's easy if you know how to search," claims Cousineau.
With the inaugural year of the EBM program behind them, the interns, who will enter their second year of residency in July, will next participate in a hands-on project. "They will address the quality and safety of patient care using the principals of EBM learned in the past year," explains Dr. Suresh. Mentored by individual faculty members, second-year interns will focus on issues that address the three types of quality problems in the healthcare system: over use, under use and misuse.
Challenges during the first year have enabled the teaching team to redesign and fine-tune the program. One of the big changes: a focus on common pediatric topics, rather than the exotic or unusual.
"This first year we chose questions from the morning report, and those tended to do with 'zebras,' addressing clinical situations that were unusual or infrequently encountered," notes Dr. Suresh. "Yet in daily practice, people are more likely to encounter 'horses.' During the second year we'll focus on horses, not zebras. We'll teach EBM using such topics as asthma and ear infections. This makes the program more relevant."
The team has also created a set of online tools for use in the upcoming year's program. "It's a teaching repository, including tutorials, customized for use in our program," notes Dr. Suresh.
The program is structured so that second-year interns serve as teachers for first-years. "Dr. Key's vision is that, after three years, the entire batch of residents will be fully trained in EBM, so that residents will teach the program. It will become a program run by residents for residents," adds Dr. Suresh.
"For all of us involved, this program has brought home, in a concrete way, how EBM really works. We have all been able to experience it in action," says Cousineau. "If doctors know how to search for and find the best research literature, then they are able to take care of their patient in the best way possible. When a doctor is practicing EBM, he or she is finding the best evidence for that particular patient -- his situation, his values. EBM means more than just doing what the evidence says. It's a very patient-centered approach. EBM results in the best patient care possible based on the best research available."
"In three years, we hope that everybody in pediatrics will be practicing EBM, and it will be smooth sailing. And then," proposes Dr. Suresh, "it would be great if other departments pick it up."
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