Teaching Evidence-Based
Medicine Across the Curriculum
Gundy Sweet, PharmD, FASHP
Clinical Associate Professor
University of Michigan, College of Pharmacy
Objectives
• Provide a brief overview of the UofM College
of Pharmacy curriculum specific to the
development of evidence-based medicine
skills and concepts
• Briefly discuss how the curriculum revision
process will strive to further develop these
skills
What is EBM?
• Combine the best evidence from clinically
relevant studies
• Add in your clinical expertise to determine if it
applies to the individual patient
• And incorporate the patient’s values
All done to make the best decision
for a given situation
Sackett D, 1996
Common Student (mis)Perception
•
•
•
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You don’t need to teach me this stuff….
I already know how to look for things….
I’m a Gen-Nexter
But few students have a systematic process to
identify the best evidence specific to a given
situation
• Why is that important?
• 2006: 20,824 journals (medical sciences)
•2009: > 679,000 citations added to Medline
Too many sources
of information
Information
explosion
2X
• Research information doubles every 10 years
• Explosion of mis-information
Traditional resources
often inadequate
• Textbooks can be outdated
• Many books take 1-3 years
to get to print
Readily available
search tools
• 1986: Medline available via librarians
• Today: numerous search tools readily available
More knowledgeable
patient
• 30% of adults seeing MD discuss a drug
they saw through DTC advertising
• almost ½ of these patients received a RX
for the drug
Daily need for valid
information
• 10% of drugs on market between 1975-1999
pulled from market/black box warning added
• 1/2 of all withdrawals within 2 years
Increase in number, sophistication,
and safety concerns with
drugs/medical interventions
Feeling Overwhelmed???
Information
explosion
Traditional resources
often inadequate
Too many sources
of information
Increase in number
and sophistication
of drugs/medical interventions
Readily available
search tools
More knowledgeable
patient
Daily need for valid
information
How and where are the skills taught?
• EBM Course
– EBM concepts
– How to formulate a clinical question
• Importance of clarity of the question
• Helps direct you to the most appropriate resources
• Helps ensure communication of a clear response
– How to apply the systematic approach to handling
requests for information
What is the Systematic Approach
• The systematic approach is an integral part of the EBM
strategy
• Helps search for the most relevant literature to
enhance efficiency and effectiveness
• The systematic approach is comprised of 7 steps:
1. Classify  2. Clarifying information  3. Systematic Search (3o2o1o) 
4. Evaluate  5. Apply  6. Communicate  7. Follow-up
• BUT… conducting a systematic search requires
knowledge of the advantages/disadvantages
associated with each type of information resource
Where Students Learn About Resources
• EBM Course
– Textbooks and general drug information resources
– Searching the biomedical literature
• What to use when
– PubMed, Embase, Google, IPA, Cochrane, others
– Using the internet - is it reliable?
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•
•
•
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Author credentials
Currency of the information
Source of funding
Awareness of extensions (.biz .com .edu .gov)
External validation of content
What about the primary literature?
• EBM Course
– How to find the primary literature
• Efficient and effective searching
– How to read and interpret the primary literature
• Terminology (R, DB, PC, DD, etc)
• Different types of trials (systematic reviews, economic
analyses, randomized controlled trials, case reports)
• Levels of evidence
• Appropriate statistical tests
• Assess all elements of the study, practicing on different
published clinical trials
Using EBM Skills
• EBM Course and beyond
– How do I apply the information?
• Does the information found apply to the clinical
situation (indication, age group, etc)?
• Are the results clinically important (and not just
statistically significant)?
– Is the information found sufficient to answer the
question?
– How should I communicate the information?
– Are there any ethical considerations to take into
account?
Application of EBM Principles
Therapeutics
P1 Year
•EBM Course (W)
•Reinforce identification of best
evidence
•Integrate critical appraisal to
clinical situations
Research Principles
P2 Year
•Therapeutics (F/W)
•Research Principles (W)
•Practical, application-based course
where students write a ‘practice’
research proposal
•Requires they understand and
apply EBM principles
•Study terminology
•Study design
•Searching primary literature
•Learn to logically think through a
problem and define a plan
Application of EBM Principles
Therapeutics
P1 Year
•Reinforce identification of best
•EBM Course
(W)
evidence/integrate
critical appraisal
Pcare (IPPE)
•Discuss patient cases that requires use
of best evidence
•Reinforce primary literature review
(journal clubs)
P2Project
Year
PharmD Research
•Application of•Therapeutics
research principles
(F/W)
•Emphasis on process
of conducting
•Research
Principles
research
(W)
P3 Year
•Therapeutics (F/W)
•Pcare (IPPE)
•PharmD Research (W)
Application of EBM Principles
Clinical Rotations
•Manage patients on rotations
•Reinforce primaryP1
literature
Yearreview
•Drug Information
is Course
a required
rotation
•EBM
(W)
•Conduct systematic review of topic
•Critically evaluate literature on a topic
•Retrieve/analyze/apply DI in practice
PharmD Research Project
•Application of research principles
PharmD Seminar
•Formal presentation P2 Year
•PharmD research
or topic(F/W)
review
•Therapeutics
•Requires application
of allPrinciples
EBM skills (W)
•Research
•Search/analyze/apply information to a
given situation
P4 Year
•Clinical Rotations
•PharmD Research
•PharmD Seminar
Application of EBM Principles
P1 Year
•EBM Course (W)
P3 Year
•Pcare (IPPE)
•Therapeutics (F/W)
•PharmD Research (W)
P2 Year
P4 Year
•Therapeutics (F/W)
•Research Principles (W)
•Clinical Rotations
•PharmD Research
•PharmD Seminar
EBM in New Curriculum
P3 Year
P1 Year
• Introduce DI skills,
resources, terminology
•Begin to build a toolbox
Curriculum
revision is an
ongoing, dynamic
process
P2 Year
• EBM: focus on literature
evaluation and searching (F)
• Research Principles (W)
•Therapeutics (F/W)
•EBM/ethics course
•Pcare (IPPE)
•Therapeutics (F/W)
•PharmD Research (W)
P4 Year
•Clinical Rotations
•PharmD Research
•PharmD Seminar
Goals with the New Curriculum
• Maximize active learning
– Students more involved in learning by DOING
• Increase opportunities in all courses for
students to ….
– not just KNOW the information but ….
– to have the ability to APPLY information in practice
In your packet is a document for your toolbox…
A Guide to
INFORMATION RESOURCES
University of Michigan, College of Pharmacy
TAUBMAN LIBRARY RESOURCES
RESOURCES BASED ON TYPE OF QUESTION
Questions