EBM 103:

INTRODUCTION:
Medical practice is changing; emphasis on the use of the best evidence derived from medical literature in guiding medical practice has become a global demand.
The fundamentals of this change lie in developments in clinical research over the last 30 years. In 1960, the randomized clinical trial was a rarity, today, it is accepted that no drug can enter clinical practice without a demonstration of its efficacy in a well -constructed randomized clinical trial. Moreover, the same randomized trial method is being applied to surgical therapies and diagnostic tests. Meta-analyses are gaining increasing acceptance as a method of summarizing the results of a number of randomized trials, and have deeply affected the setting of treatment policies in leading health care facilities all over the world.

A new philosophy of medical practice and teaching has followed these changes, which became apparent to the whole medical society through the following progressive changes:

• The increasing number of articles, on-the-job training, and web-based courses instructing clinicians on how to access, evaluate, and interpret medical literature.
• Appearance of practice guidelines based on rigorous methodological review of the available evidence.
• Applying the principles of clinical epidemiology to the day-to-day clinical practice in most of the leading health care institutes all over the world.
• Journals focusing onpublications of high relevance and of methodological rigor.
• Adoption of a more informative structured abstract format by major medical journals, incorporating issues of methodology and study design into the portion of an article first seen by the reader.
• Appearance of textbooks which provide a rigorous review of available evidence, including a ‘methods’ section, describing both the methodological criteria used to systematically evaluate the validity of the clinical evidence and, the quantitative techniques used for summarizing the evidence.

RATIONALE:
The influence of evidence-based medicine on clinical practice and medical education is increasing. Clinicians are required to be constantly aware of current best evidence to optimize patient care outcomes. The clinician needs to learn to access, select, appraise and appropriately utilize up-to-date medical information in order to maintain the standards of his practice. The clinician should be skilled in navigating useful internet sites, and in the use of appropriate search engines for locating current best evidence.

GOAL:           
The goal of this program is to educate clinicians in the practice of evidence-based medicine. This program is designed to provide clinicians with the skills and knowledge required to bring evidence- based medicine into their daily practice, by stressing upon the examination of evidence from clinical research, and de-emphasizing intuition, unsystematic clinical experience, and patho-physiologic rationale as sufficient grounds for clinical decision-making.

PROGRAM DESCRIPTION:
This is a 3 day training program which will allow clinicians to attain knowledge and develop the skills and attitudes required as the basis for the integration of Evidence- Based Medicine into their clinical practice.


LEARNING OBJECTIVES: 
Evidence-based medicine requires new skills of the physician, including efficient literature-searching, and the application of formal rules of evidence in evaluating clinical literature.
By completing this program the participating clinician is expected to achieve the following objectives:

• Define the terms: EBM, POEMs, DOEs, and Information Mastery.
• Describe the importance of an evidence-based approach to clinical practice.
• Apply Information Mastery to the management of the medical literature.
• Define the importance of clinical questions.
• Create well-formed “PICO” clinical questions.
• List the characteristics of different study designs.
• List the type of ‘study design’ required to answer each clinical situation.
• Define the Priority of different questions according to certain criteria.
• Develop a search strategy.
• Define the terminology and methods of searching the MEDLINE database.
• Perform a structured web search following an efficient search strategy.
• Identify the web sites where relevant information may be sought.
• Develop skill in searching for relevant literature using the internet.
• Identify the steps of evaluating literature dealing with diagnostic techniques.
• Calculate sensitivity and specificity, positive and negative predictive values and likelihood ratios for different diagnostic tests.
• Appraise literature dealing with diagnostic tests using a specifically designed worksheet.
• Determine if a study about therapy is relevant and valid.
• Analyze study results on an “intention to treat" basis.
• Distinguish between “relative risk reduction” and “absolute risk reduction”.
• Calculate the “number needed to treat” (NNT) in a study.
• Explain the steps of performing a meta-analysis: identification, selection, abstraction, and analysis.
• Distinguish between random and fixed effects models when reading a meta-analysis
• Evaluate the relevance, validity and usefulness of a meta-analysis.
• Critically appraise a simple meta-analysis.

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