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Traditional Expert-Based Information Delivery Systems

Traditional Expert-Based Information Delivery Systems. Using an Expert, Being an Expert. Roles of Experts. Consultation CME Review articles Practice guidelines Decision analysis. Using an Expert/Being an Expert. Definition of an expert

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Traditional Expert-Based Information Delivery Systems

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  1. Traditional Expert-Based Information Delivery Systems Using an Expert, Being an Expert

  2. Roles of Experts • Consultation • CME • Review articles • Practice guidelines • Decision analysis

  3. Using an Expert/Being an Expert • Definition of an expert • Subspecialist or primary care clinician with special interest • Anyone/anything you go to for an answer to a question

  4. Using an Expert/Being an Expert • “Never ask the barber whether you need a haircut” • “So many specialists fall into the habit of looking where the light is -- that is, offering solutions only in territory familiar to them. . . Wonderful examples exist of otherwise excellent researchers who are unable and unwilling to recognize evidence contrary to their beliefs.”

  5. Usefulness Score • Work: Low • Significant potential for usefulness • Relevance: Varies • Validity: Expert dependent • If either relevance or validity is zero, usefulness is zero

  6. Types of Experts • Content Expert • Clinical Scientist • YODA

  7. Content Expert • Experienced, particularly diagnosis and procedures, not necessarily therapy • Not trained in clinical epidemiology (validity) • Traditional education favors DOEs (relevance) • May not be current, may rely on anecdotes • Risky extrapolation: Information is only as current as the last consultation

  8. Clinical Disagreement Between/Within Experts • Same film: disagree 29% of time • Previous read: disagree with self 20% of time • Studied with venograms, fundi, MRI, angiography, mammograms, pathology (melanoma diagnosis) • March 97 Bandolier on the Web: “Histology as Art Appreciation”

  9. “Never ask a barber . . .” • Chalmers: Recommendation highly correlated with training and source of income • Management of acute GI bleed • Surgeons: surgery- 50%; conservative- 15% • Internists: surgery- 15%; conservative- 50%

  10. Clinical Scientist • Good at evaluating evidence; up-to-date, don’t have to be content experts • Separation of therapeutics • Medical Librarian, PharmD

  11. YODA: Your Own Data Analyzer • Content expert and clinical scientist • Consider POEMs first, even if this information conflicts with DOEs or clinical experience • When POEMs not available, use best DOEs with an open mind • Demonstrate appropriate validity assessments • Not to be confused with YUCKs

  12. YUCK • YOUR • UNSUBSTANTIATED • CLINICAL • KNOW IT ALL

  13. Experts gone wrong: YUCKs

  14. YUCK • Your Unsubstantiated Clinical Know-it-all • Maladaptive • Rigid, Dogmatic • All personality types, but people who see things in Red and Green can fall into the YUCK trap

  15. The Golden Question: “That’s interesting . . . Is there any evidence that . . . ?”

  16. If it’s not a valid POEM, it’s just not necessarily so

  17. Making the Most of a CME Presentation

  18. Dilbert’s Take on CME

  19. Continuing Medical Education • People remember 90% of what they do, 75% of what they say, but only 10% of what they hear • How to make the 10% count

  20. Do We “Get” Something From CME?

  21. Is post-test performance improved? (DOE) • YES • Beware “Chinese-Dinner Memory Dysfunction”

  22. Are patient outcomes improved? (POEM) • No . . .Multiple RCTs have failed to find a benefit from traditional lecture format (passive) • Maybe . . . with active (hands-on) workshops combined with close follow-up

  23. Usefulness • Validity: Depends on the speaker • Relevance: Depends on POEM:DOE ratio • Work: Higher than it seems • NBA analogy (only last two minutes count) • Tracking down validity of new POEMs

  24. Role of the Speaker • Present a good mix of POEMs highlighted by clinically relevant DOEs • Augment POEMs with clinical experience • Identify Level of Evidence (LOE)for listener

  25. Role of the Listener • Identify, before the talk begins: • What you want to learn • What are the POEMs you need to know? • Actively evaluate information (CME worksheet) • When a change-inducing POEM is presented, validate: • By questioning the speaker • By cross-checking with other sources

  26. Identifying “Common” POEMS • Will this information have a direct bearing on the health of my patients (is it something they care about)? • Is the problem common to my practice? • Is the intervention feasible? • If true, will it require me to change my current practice?

  27. Newer Models for CME • Practice-based small group CME • Educational prescriptions • Point of care Sources • Team-based learning • Audience response systems • CME worksheet • Social media

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