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e-Learning Evidence-based Medicine

e-Learning Evidence-based Medicine. Katrien Oude Rengerink Academic Medical Center Dept. of Obstetrics and Gynaecology The Netherlands. Contents. What is Evidence-based Medicine? Why e-learning modules EBM? e-learning basic principles EBM e-learning modules Teach-the-Teacher EBM.

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e-Learning Evidence-based Medicine

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  1. e-LearningEvidence-based Medicine Katrien Oude Rengerink Academic Medical CenterDept. of Obstetrics and Gynaecology The Netherlands EBayesMet conference October 2011

  2. Contents • What is Evidence-based Medicine? • Why e-learning modules EBM? • e-learning basic principles EBM • e-learning modules Teach-the-Teacher EBM

  3. What is EBM? DaveSackett BMJ 1996: “Good doctors use individual clinical expertise, the best available external evidence as well as patient preferences, and neither alone is enough.”

  4. Reduction Number Needed to Read • 120+ journals scanned • 50,000 articles • Is it valid? (<5%) • Intervention: RCT • Prognosis: inception cohort • Etc • Is it relevant? • 6-12 GPs & specialists asked:Relevant? Newsworthy? • < 0.5% selected www.evidence-basedmedicine.com Number Needed to Read is 200+

  5. Why EBM? • Exponential growth knowledge • Integration research into clinical practice slow  evidence summaries important  skills for knowledge translation important

  6. 5 steps of EBM

  7. Theory of the Stork vs Theory of Sexual Reproduction R2 0.49, p<0.05

  8. Evidence supporting Theory of Stork Storks exist Unexplained features fetal development Sexual intercourse without delivery Correlation birth rate - stork population Storks not seen in hospitals: apparently medical interventions may replace storks EBM: hierarchy in evidence sources

  9. Organisation of evidence

  10. Parachute use to prevent death: systematic review of RCTs • Parachutes used to prevent death and major injury due to gravitational challenge • Free fall studies: no 100% mortality • No RCT: basis use purely observational. Apparent efficacy potentially explained by a ‘healthy’ cohort effect. • No evidence  do not use intervention  Some effects not need RCT

  11. Why e-learning EBM? • Clinical professionals value EBM important, but slow integration and application in practice • Huge variation EBM content and education Europe • Interactive, clinically integrated education best way learning and applying EBM • Current available courses useful, but: - minimum integration clinical practice- low flexibility

  12. Leonardo I An European e-learning course in Evidence Based Medicine

  13. Partners • UK • University of Birmingham/Birmingham Womens’ Hospital • CASP International • Germany - Agency for Quality in Medicine • Poland - CASPolska • Spain - CASPe • Hungary - TUDOR • Italy - Universita Cattolica del Sacro Cuore • Switserland - Basel Institute for Clinical Epidemiology • The Netherlands - AMC Independent steering commitee

  14. Aim • Familiarise participants with EBM basics to help incorporate evidence from systematic reviews on therapeutic interventions into daily clinical practice • Harmonise EBM teaching across Europe • Short, individual e-learning sessions • On-the-job training

  15. Course content 1.Defining clinical questions 2. Searching the evidence 3. Appraisal of the systematic review a. Validity of RCTs b. relative risk and 2x2 table 4. Applying evidence to patient 5. Implementation of evidence into practice

  16. Instruments for evaluating education in EBM 4 EBP domains: • Knowledge • Skills • Attitude • Behavior • enacting EBP steps in practice • permorning evidence-based clinical manoevers • affecting patient outcomes

  17. Course evaluation • 101 participants from Switserland, Germany, Hungary, Spain, UK • Pre- and postcourse assessment • Knowledge/skills: modelled Berlin Questionnaire • Attitudes: questionnaire by Taylor L. et al.

  18. Results • Across all countries, knowledge scores improved from pre- to post-course for all five modules (p<0.001) (paired Wilcoxon signed ranks test) • After completing course participants felt more confident that they can assess research evidence E-learning at least equally effective as regular teaching

  19. Leonardo II Evidence Based Medicine: Training the Trainers across the healthcare sector

  20. Background • During Leonardo I & Sicily EBM conference: need support teaching EBM in practice • low level EBM teaching in clinical practice possibly due to lack of confidence to teach EBM in workplace • Complementary to existing EBM programmes: exploit learning opportunities in clinical setting  Leonardo II

  21. Partners England (lead): University of Birmingham/Birmingham Women’s Hospital J&B Associates Italy – Universita Cattolica del Sacro Cuore Poland - CASPolska Hungary - TUDOR Switserland - Basel institute of clinical epidemiology Netherlands – AMC Germany – AzQ

  22. Aim • Train trainers to teach EBM through on-the-job training, by demonstration of applied EBM, to encourage clinically relevant teaching of EBM in post-graduate education • Develop European standard in EBM education • Target: clinical teachers who teach EBM in clinical practice to postgraduates

  23. Course contents Based on teaching opportunities modules developed for 6 clinical settings: Learner-centered (e-learning) Problem-based Video clip incorporated Applicable in Europe

  24. Teaching opportunities in clinical practice

  25. Example: Teaching and learning EBM during ward rounds Outline: Learning objectives Pre-requisites to undertake the module Learning opportunities EBM steps Example Video clip (3 min) Teaching and learning lesson Conclusion

  26. Course evaluation • 5 countries: about 10 clinical teachers who teach EBM to postgraduates per country piloted • Pre- and postcourse assessment using ‘Basel questionnaire’  e-learning course on how to teach EBM in various settings is feasible and effective.

  27. Barriers EBM teaching • 120 clinical EBM teachers from 11 countries completed questionnaire regarding barriers for EBM teaching • Barriers: • lack of time in busy practice • lack of requirements for EBM skills • pyramid hierarchy in health care management structure.  Teaching EBM in clinical settings is most successful where EBM principles are culturally embedded and form part and parcel of everyday clinical decisions and medical practice.

  28. Availability Free available in: English German French Polish Hungarian Accessible through: www.ebm-unity.org

  29. References • Sackett, BMJ 1996 EBM what is it and what isn’t it? • Höfer T, Przyrembel H, Verleger S. New evidence for the Theory of the Stork. Paediatric and perinatal epidemiology. 2004(18):88-92. • Smith GCS, Pell JP. Parachute use to prevent dath and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ 2003. • Khan AT, Mehr MN, Gaynor AM, Bowcock M, Khan KS. Is general inpatient obstetrics and gynaecology evidence-based? A survey of practice with critical review of methodological issues. BMC Women’s Health 2006(6):5. • Khan KS, Coomarasamy A. A hierarchy of effective teaching and learning to acquire competence in evidence-based medicine. BMC Med Educ 2006:15(6):59. • Coppus SFPJ, Emperanza JI, hadley J et al. A clinically integrated curriculum in Evidence-based medicine for just-in-time learning through on-the-job training: The EU-EBM project. BMC Medical Education 2007(7):46. • Shaneyfelt T, Baum KD. Instruments for evaluating education in evidence-based practice: a systematic review. JAMA 2006;296(9):1116-1127. • Kulier R, Hadley J, Weinbrenner S et al. Harmonising Evidence-based medicine teaching: a study of the outomes of e-learning in five European countries. BMC Medical Education 2008(8):27. • Taranganitam S, Barnfield G et al. Teaching trainers to incorporate evidence-based medicine (EBM) teaching in clinical practice: the EU-EBM project. • Oude Rengerink K, Thangaratinam S. How can we teach EBM in clinical practice? An analysis of barriers to implementation of on-the-job EBM teaching and learning.

  30. Thanks to Leonardo I Regina Kulier Julie Hadley Susanne Weinbrenner Berrit Meyerrose Tamas Decsi Andrea Horvath Eva Nagy Jose Emparanza Sjors Coppus Theodoris Arvantis Amanda Burls Juan Cabello Marcin Kaczor Gianni Zanrei Karen Pierer Katarzyna Stawiarz Regina Kunz Ben Willem Mol Khalid Khan Steering committee Leonardo II Shakila Thangaratinam Gemma Barnfield Theodoros Arvanitis Susanne Weinbrenner Khalid Khan Berit Meyerrose Andrea Horvath Gianni Zanrei Regina Kunz Katja Suter Jacek Walczak Anna Kaleta Javier Zamora Harry Gee Ben Willem Mol Maciej Nogas Bernard Burnand Chantal Arditi

  31. Katrien Oude Rengerink: K.OudeRengerink@amc.uva.nl www.ebm-unity.org

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