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Introduction There are limited data on best approaches for evidence-based medicine (EBM) teaching to residents in busy continuity clinic practices. Ambulatory Teaching Minute (ATM) exercises were designed to deliver brief, case-based, faculty-facilitated teaching to residents on high-yield ambulatory EBM topics. Methods I developed four ATM exercises, with each one-page handout containing a clinical case, a guided discussion of a research question and study design sparked by the case, a synopsis of a recent research article addressing this question, and a teaching guide for facilitation. Internal medicine residents received these ATM exercises over the course of their monthlong ambulatory block. Surveys that assessed resident engagement were obtained from faculty-facilitators (N = 4) and residents (N = 6) at the end of the ambulatory block. Results Residents were actively engaged in the exercise, with an average engagement score of 3.81 out of 5. Most respondents reported ATM exercises taking 6–10 minutes. The majority of respondents felt ATMs could be realistically completed once per week. Discussion In this preliminary assessment of a new tool for EBM teaching in clinic, positive engagement scores among preceptors and residents highlight the potential of ATMs to efficiently and effectively address EBM topics during limited teaching time in clinic.

Abstract Introduction Numerous studies have demonstrated that many physicians lack fundamental skills in interpreting and using clinical care evidence. We hypothesized that building a foundation for evidence-based medicine (EBM) prior to the clinical years would provide an initial scaffold that could be integrated during clinical training. Many schools have interpreted LCME standard ED-17 as synonymous with instruction in EBM. Methods This was one of nine modules in EBM skills for first-year and second-year medical students, who were novices in EBM knowledge. The two-part module began with a 2-hour, in-class didactic covering the fundamental features of risk and harm studies, including internal study validity, and study results. Between 1 and 14 days later, students then participated in a 2-hour interactive large-group EBM exercise during which they applied their knowledge and practiced forming judgments for overall study validity. The large-group exercise is based on principles of team-based learning (TBL), but does not follow them exactly. Results We performed a pre-post assessment of alternative items (10 pre, 12 post) covering the same objectives. The preassessment scores were 175 correct and 215 incorrect (difficulty 44.87%). Postassessment scores were 421 correct and 47 incorrect (difficulty 89.96%). Discussion The mode of instruction is highly adaptable. In previous years, the module followed strict TBL pedagogy for the application exercise, and this EBM exercise can easily be converted back to a traditional TBL by having teams simultaneously report answers using whiteboards or flipcharts and then debating their choices. In addition, the initial didactic session can be prerecorded for students to review before class.

Abstract This case, which evolves over three sessions, describes the course of a pregnant woman from the Dominican Republic who presents to the emergency department complaining of abdominal pain. Developed by faculty from multiple clinical departments, this case allows learners to integrate and apply collected data to problem-solve. It also helps students develop the skills necessary for the interpretation and utilization of relevant historical, physical examination, and laboratory information in a patient who is acutely ill. Topics addressed in the exercise include symptom presentation/evolution, generation of differential diagnosis, diagnostic testing, and patient management. The exercise reiterates the clinical relevance of basic science topics, including embryology, anatomy, pharmacology, physiology, and pathophysiology. It also allows students to address culture, intimate partner violence, health beliefs, population medicine, and evidenced-based practice. The problem-based format fosters self-directed learning, reflection, and collaborative practice. Student evaluations have consistently indicated that the exercise has helped them to think about a clinical case in a multidisciplinary fashion, across specialty lines, and from a cultural perspective. Since first implementing this case in 2003, we have recognized the benefit of having fourth-year students cofacilitate the exercise. We have also involved the medical library staff in the implementation of this exercise to provide students with an additional resource to help them with more challenging literature searches. This problem-based learning exercise allows third-year medical students to consolidate educational experiences from across their clerkships and encourages multidisciplinary thinking in their clinical interactions. The strength of the case is that students are required to think outside the context of a specific clerkship and integrate symptoms across organ systems.

Abstract Created and maintained by the Boston University Alumni Medical Library, this web-based tutorial designed for self-study can be completed in approximately 5 minutes and can be used to support evidence-based medicine (EBM) practice and curricular components. The major educational topics addressed include the impact of the clinical question on EBM research, the key elements of a clinical question, how to form an answerable clinical question, and the role of the clinical question in the overall EBM process. Geared towards evidence-based practitioners and medical students (graduate and undergraduate), this tutorial is structured around an otitis media case. Through the step-by-step identification of the patient, intervention, comparison, and outcome (the PICO process), the case actively guides users in building an answerable clinical question. Due to the tutorial's interactive nature, users are engaged throughout and are asked to input information that is later revisited so they can note their progress. To ensure quality, the tutorial was reviewed by a family medicine physician. Links to related guides and worksheets are provided.

Abstract Introduction Educators have recently been challenged to actively incorporate instruction that emphasizes cultural diversity, access to health care/health care disparities, evidence-based medicine, and reflection regarding impact of physician's values and beliefs on the patient care. Methods Framing these issues as a three-perspective approach to patient-centered care, this two-part workshop is designed teach learners how to incorporate the patient's, physician's, and society's perspective into a health care plan and provide opportunities for learners to apply this approach using a series of strategically crafted instructor-authored cases and at least one student generated “critical incident” case scenario. Results The learners evaluated the patient-centered care workshop using a combination of Likert-scale questions and comment opportunities linked to workshop objectives, format and impact on learner's ability to provide patient-centered care. Postworkshop, the evaluation forms were tabulated using descriptive statistics (e.g., frequency, mean, standard deviation) for each question. Overall, learners reported that the session merited a grade of high pass (unusually high rating for learners). Incorporation of the critical incidents into the discussion was reported by 82% of learners (N = 194) and 99% of learners reported that the workshop prepared them to continuously apply the Kleinman's questions to obtain each patient's perspectives on health, disease, illness, and treatment. Discussion Suitable for medical students, residents, or practicing physicians, this workshop can be adapted from its 4-hour format into smaller units. The packet contains a detailed instructor and facilitator guides, PowerPoint slides with speaker notes, cases, critical incident and workshop evaluation forms, and references needed to lead the workshop.

Abstract Introduction The emergency department (ED) is the primary teaching site for emergency medicine residency training programs where the diversity of patients' medical needs provides learners with a unique opportunity to participate in clinical research. We created this course to introduce EM residents to the fundamentals of research and evidence-based medicine (EBM) to help them explore a future career in clinical research, but also to equip them to be lifelong learners. EBM is the integration of evidence, experience, and values into clinical decision-making and enables clinicians to become informed consumers of the medical literature. Methods This publication includes four narrated video lectures on the basic concepts of EBM that students review at their own convenience. At our institution the review of these videos is followed by a test to evaluate the knowledge gain. These videos are part of a larger course wherein students (1) receive lectures on basic clinical research principles and research ethics, (2) complete the Human Subjects Protection test, and (3) participate in 15 four-hour shifts in the ED enrolling patients into clinical research studies. Results The students' evaluations of the course indicate that they value the experience. Participants state that they are much more comfortable with the basic concepts and vocabulary of EBM. They also indicate that they are not only more comfortable with the basic concepts of research methodology but also with the challenges and rewards of clinical research. Discussion This course provides an opportunity for medical students to become familiar with the basic skills needed to efficiently and effectively evaluate medical literature (a vital piece of practice-based learning). In addition, it exposes students to clinical research in their medical school careers and sparks interest for future involvement.

Abstract This interactive program takes learners through the evidence-based medicine (EBM) process for therapy articles using two illustrative cases involving pediatric examples. The steps in the EBM process are asking questions, finding evidence, and appraising information. While the two cases are designed for students or residents, the material can easily be adapted for use in a variety of settings and for all levels of learners.

Abstract This resource is a web-based tutorial that educates health care providers about culture, faith traditions, and health. Tutorial materials offer important information on complementary therapies, of which there is very little generally available. The online format matches well with new models of medical education emphasizing individualized learning and innovative tools. The tutorial meets competencies for medical, nursing, and pharmacy education. The tutorial is organized into sections in which self-study modules provide definitions of commonly used concepts, an opportunity to consider one's own cultural perspective, an exploration of the impact of culture on health care interactions, an overview of the National Standards for Culturally and Linguistically Appropriate Services, an introduction to cultural assessment tools, and patient scenarios demonstrating the importance of conducting a cultural assessment. These modules have interactive features, including audio, links to relevant organizations, a list of comprehensive references, and a concluding self-assessment quiz based on the learning objectives. Some faculty replace a reading assignment or class lecture with the online tutorial, then use class time for discussions arising from the tutorial—often springing from the reflective questions or case studies included in the tutorial. Other faculty use the tutorial as a resource for class projects. The tutorial is designed to allow direct access to any section, so learners can quickly find information relevant to their immediate needs.

Abstract This web-based tutorial seeks to educate health care providers about complementary therapies and healing practices. Written and reviewed by experts drawn from the University of Minnesota Medical School and community, it meets competencies for medical, nursing and pharmacy education. Organized into sections, the self-study modules provide a discussion of the historical and political background of this field, a summary of the evidence base, and practical suggestions on what health care professionals can do to address complementary therapies in their practices. The module has interactive features, including audio and video, links to relevant organizations, a list of comprehensive references. The module concludes with a self-assessment quiz based on the learning objectives. The materials offer important information on complementary therapies, of which there is very little generally available. The online format matches well with new models of medical education that emphasize individualized learning and innovative tools. Online learning offers great flexibility to faculty and students. It was discovered that the individual online tutorials can be used in different courses in multiple ways. Some faculty replace a reading assignment or class lecture with the online tutorial, then use class time for discussions arising from the tutorial. Other faculty use the tutorial as a resource for class projects. The tutorial is designed to allow direct access to any section, so learners can quickly find information relevant to their immediate needs.

Abstract This website provides access to a set of calculators and interactive online exercises for the practice and teaching of evidence-based medicine and decision analysis. Major concepts presented include interpretation of diagnostic tests (calculation of test statistics, visualization of test results, and an online self-quiz), calculation of number needed to treat/harm in randomized controlled trials, approaches to the assessment of patient utility (including holistic and multiattribute utility assessments), and demonstrations of Markov models and cost-effectiveness analysis. The calculators on the webpage have been widely and internationally used in the practice of evidence-based medicine. Although there are some similar resources, many of these have stronger requirements for the web browser (e.g., JavaScript), which may limit their usability.

Abstract This manual provides background, learning objectives, and teaching materials for faculty who are interested in teaching evidence-based medicine (EBM) to students, residents, and colleagues. One section focuses on faculty development in this important curricular area. The teaching materials include modules centering on the steps in the EBM process (asking questions, finding evidence, and appraising information), followed by four role-play cases. Although the cases are designed for pediatric residents or faculty, they can easily be adapted for use in a variety of settings and with all levels of learners. The material in this manual can be delivered with no difficulty by faculty who have an interest in and some basic understanding of EBM.