TEACHING EVIDENCE BASED PRACTICE
Random thoughts in a nutshell
Robert J. Weyant, DMD, DrPH
Chair, Department of Dental Public Health
University of Pittsburgh School of Dental Medicine
Who we teach
•
Dental students
•
Dental faculty
•
Practicing dentists
What do we teach
•
Just in time (not just in case) individual patient
treatment decisions.
•
Some use of guidelines.
Challenges: Dental Students
Challenges
•
Lack of clinical knowledge
•
Lack of vocabulary
•
Lack of understanding of
practice needs
•
Busy with “real” dental
courses
Opportunities
Challenges: Faculty Members
Challenges
Opportunities
•
Already know everything
•
Captive audience
•
Busy
•
•
Don’t “get it”
Access to medical library
(online resources)
•
Don’t want to look foolish
•
Don’t want to look foolish
Challenges: Practicing Dentists
Challenges
•
Busy
•
Lack access to online
resources
•
Economic concerns
Opportunities
•
Eager (if paying for CE)
Didactic Teaching
First Year EBD Course
Second Year Research Course
Start with a strong rationale
Dental Students
•
•
Just want the “answers”
Practitioners
•
•
Lack Perspective
•
Don’t understand that
science/practice changes
Strong Rationale
Need to see examples.
•
They already practice
EBD…
Manage fear of change
Demanding evidence… she averted a US tragedy.
Strong Rationale
Francis Kelsey, MD
Carl Henegan, Oxford
Julies Back to Sleep slide
Bad things happens
when we don’t look at
evidence
Strong Rationale
Many “Leaks” from research to practice
Aware Accept Target Doable Recall Agree Done
Valid
Research
If 80% achieved at each stage then
0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
Strong Rationale
Paul Glasziou
Teaching Philosophy: Dental Students
•
Start early in curriculum
•
Easy and Rewarding
•
Reinforce for all four years
•
Skill development
EBD Taught Early and Often
D1
Didactic
EBD/Stats
Clinical
Case
presentation
Adolescent
clinic
Start Early
D2
D3
D4
First-year course
•
Classic EBD material
•
Just enough stats
•
Asking (PICO)
•
Descriptive (review)
•
Accessing
•
P-value
•
Assessing
•
Confidence interval
•
Applying
•
Measure of effect
•
Diagnostic Test
Weyant’s Rules for Easy and Rewarding EBF
Secondary Sources ONLY (at first)
No wild goose chases
Keep it simple (at first)
Search Strategy
Question (PICO)
Check MeSH
Check for 2nd Sources
Here:
• TRIP
• Cochrane
• ADA EBD
• NGC
Search 2nd
Sources
No
PICO – search
strategies for
PubMed
PubMed
(Clinical Queries)
Yes
STOP
Weyant’s Rules for Teaching Statistics
Formulas = Failure
Less is More
Teach for Consumption
Make it Sticky
Important concepts:
Education is the path from cocky
ignorance to miserable uncertainty.
Mark Twain
Uncertainty
Important concepts:
Lack of Evidence
There is insufficient evidence to determine the
effects of routine scale and polish treatments.
High quality trials conducted in general dental
practice settings with sufficiently long follow-up
periods (five years or more) are required to
address the objectives of this review.
In three studies, the panel found
no benefit of using prophylaxis
pastes containing fluoride on
the primary or permanent teeth
of children.
Worthington et al., Routine scale and polish for periodontal
health in adults. Cochrane Review, 2013
Weyant et al., Topical fluoride
recommendations, JADA 2013
Absence of Evidence
Evidence of Absence
Important concepts:
 Study size and p-value?
 Surrogate endpoints
 NNT
Clinical Significance
EBD Taught Early and Often
D1
Didactic
EBD/Stats
Clinical
Case
presentation
Adolescent
clinic
Reinforce in clinic 4 yrs
D2
D3
D4
EBD Taught Early and Often
D1
Didactic
EBD/Stats
Clinical
Case
presentation
Adolescent
clinic
Reinforce in clinic 4 yrs
D2
Research Skills
Course
D3
D4
[Case
Presentation]
Senior Case
Presentation
EBD Clinical
Worksheets
EBD Clinical
Worksheets
Experiential Learning
EBP is a SKILL and requires PRACTICE
POGIL
Sessions
Simulated
Cases
Clinical EBD
Worksheets
Small Group Teaching
POGIL
Case-Based Learning (HPDP)
Processed Oriented Guided Inquiry Learning
(POGIL)
https://pogil.org/about
 Self managed teams
 Guided exploration to construct learning
 Focuses on higher level thinking skills
POGIL: The Model
Model 1
Model 3
The POGIL Process
Learning Cycle
Process Skills
1. A Question
2. Observation or data collection to
DEVELOP concept.
3. Guide to conclusion
4. Application
•
•
•
•
•
•
Teamwork
Oral + written communication
Management
Problem solving
Critical Thinking
Assessment
Small Group Case Based Learning
•
•
•
•
SES: High
Knowledge of oral disease: good
Medical: Type 1 Diabetes
Dental:
–
–
Regular utilization of dental services.
No sealants
•
•
•
•
•
Minor Plaque
No calculus
Slight gingivitis
No Caries or restorations
Occlusion –
•
under treatment for overjet and
crossbite
ADA Sealant Recommendations
ADA Guidelines on
topical fluoride
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Clinical Teaching
EBD Worksheet
Senior Case
What’s different about teaching graduates (faculty and practicing
dentists)?




Adult Learning Model
Shorter course
Different rationale
More cognitive bias and cognitive dissonance
Where do we go from here…
Full implementation of Evidence-based Program
•
•
•
Risk Assessment
Diagnostic Codes
Summary Reports
axiUm
Faculty training
(coaching)
Policy
changes
Robert J. Weyant, DMD, DrPH
Chair, Department of Dental Public Health
University of Pittsburgh School of Dental Medicine
rjw1@pitt.edu
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