Our Experience Running an EBM
Subcourse in our Pediatric Clerkship
Patricia G. McBurney, M.D., MSCR,
Associate Professor, Pediatrics,
Co-Director, Pediatric Clerkship,
Medical University of South Carolina
843 876-8512
mcburnpg@musc.edu
www.MUSCkids.org
I have no information to disclose and no conflicts of interest.
Our subcourse is published:
•
McBurney P, Knoll ME, Hulsey T, Jackson S. Evidence-based Medicine
Subcourse to the Pediatric Clerkship. MedEdPORTAL Publications;
2014. Available
from: https://www.mededportal.org/publication/9936http://dx.doi.org
/10.15766/mep_2374-8265.9936
•
McBurney PG, Knoll ME, Hulsey TC, Jackson SM. Evidence-based
Medicine Subcourse to the Pediatric Clerkship: The Students’
Perspective. Poster Presentation at 2014 Council on Medical Education
in Pediatrics, Ottawa, Canada.
www.MUSCkids.org
Acknowledgements
Sherron M. Jackson, MD, Co-Director of Pediatric Clerkship, MUSC
Michele Knoll Friesinger, MA, CHES, Office of Assessment and Evaluation, MUSC
Tom Hulsey, PhD, School of Public Health, West Virginia University
Laura Cousineau, MLIS, Director of the Biomedical Libraries in the Dartmouth College
Library
Emily Brennan, MLIS, Assistant Professor in Pediatrics and Informationist/Research
Librarian, MUSC.
Christine Talbot-Bond, MA, Pediatric Clerkship Coordinator, MUSC (former)
Melinda Slider, Pediatric Clerkship Coordinator, MUSC (current)
1000+ Wonderful medical students who have taken this subcourse!
www.MUSCkids.org
Objectives
• Discuss the objectives and advantages/disadvantages of
teaching EBM during a pediatric clerkship.
• Describe how an EBM activity can meet the LCME (Liaison
Committee on Medical Education) definition of active
learning while providing opportunities for student
teamwork and peer evaluation.
• Develop ideas on how to effectively and efficiently teach
or practice EBM skills in different clinical and educational
settings.
www.MUSCkids.org
Why teach EBM during a
pediatric clerkship?
• Clerkships capture all the students.
•
EBM skills are universally important to all medical
students regardless of specialty choice (Council on Medical
Student Education in Pediatrics’s Third Year curriculum,
COMSEP 2012).
• Clinical Integration is key in order to achieve competency
in knowledge, critical appraisal skills, and attitude and
behavior. (Coomarasamy &Khan, 2004; Ilic & Maloney,
2014).
www.MUSCkids.org
Limitations of teaching
EBM on a pediatric
clerkship.
•
Short-time frame (6 week clerkship at MUSC (6 week clerkship at
MUSC with 160+ students/year), and so efficiency is essential.
Efficiency is important for students as well as preceptors.
•
Short-time frame limits our influence on the students’ attitudes and
behaviors with EBM.
•
Repetitious (every 6 weeks gets old) for the preceptors so the course
should allow the students some creativity.
•
Buy-in from the students that the skills are important for their entire
careers and regardless of specialty. On a clerkship, students tend to
focus on the short-term (evaluations and exam scores). Buy-in was OUR
BIGGEST CHALLENGE!
www.MUSCkids.org
Pediatric EBM Subcourse
History
www.MUSCkids.org
Pediatric Clerkship EBM
Subcourse
Purpose:
To provide an effective and efficient method to
train 160+ third year medical students in the use
of the medical literature as they rotate through
the 6 week pediatric clerkship. It allows the
development of active learning, team work, and
peer-evaluation skills.
What the subcourse is NOT: an explicit
curriculum to teach appraisal skills
www.MUSCkids.org
Pediatric Clerkship EBM
Subcourse
Objectives:
• Demonstrate the ability to identify deficiencies in
personal or the medical team’s knowledge and to
apply evidence-based medicine strategies to improve
knowledge.
• Demonstrate collaborative skills with peers in
working to answer clinical questions and to teach
about the knowledge gained.
• Formulate a clinical question, search the literature,
demonstrate evaluation skills and apply the evidence
into patient care and clinical decision-making.
www.MUSCkids.org
Pediatric Clerkship EBM
Subcourse
Prerequisites:
During the COM2 year at MUSC:
1. series of lectures on epidemiology,
statistics and study design
2. study critical appraisal
3. review and assessment of relevant
articles to answer clinical questions
www.MUSCkids.org
Pediatric Clerkship EBM
Subcourse
Preceptors:
At MUSC, we have the great fortune of having
research librarians who are faculty with time
dedicated to EBM.
Physicians have filled the role as needed.
What a preceptor needs to have:
1. Solid grasp of and enthusiasm for EBM.
2. Willingness to continuously learn from the
students’ questions and projects.
3. Time.
www.MUSCkids.org
EBM Subcourse Structure
Orientation to the Pediatric Clerkship – EBM Subcourse introduced
Midpoint Feedback for the Pediatric Clerkship – EBM check progress
Final Feedback for the Pediatric Clerkship – Allows student input
MAIN COMPONENTS of SUBCOURSE:
EBM Review (first week of rotation)
EBM Finale (last week of rotation)
SUPPLEMENTARY COMPONENTS:
Rounds with the EBM Preceptor Present
Resident EBM Conferences
www.MUSCkids.org
EBM Subcourse – Main
Components
EBM REVIEW Student Preparation
Scripted clinical scenario that directs the students to a clinical question.
Assignment:
1.
put the question into PICO/PICOTT* format
2.
Describe their search strategy
3.
Provide the citation of the article which answers the question
4.
Summarize the results of the study and how it applies to the scenario
Due Date: the day after orientation, generally.
Email assignment to clerkship coordinator and EBM preceptor (librarian).
Group Work: Students may work in groups. We suggest their assigned
groups for the EBM Finale (for MUSC are the ward teams, 6 groups of 3-4
students).
*Patient/Population/Problem, Intervention, Comparison, Outcome/Type of Question, Type of
Study
www.MUSCkids.org
EBM Subcourse – Main
Components
EBM REVIEW Preceptor Preparation
Review the Submitted Assignments: 24 hour
period to review these assignments
Feedback: written on the assignments
(forms are returned before or at the EBM
Review Session) AND verbal at the EBM
Review Session
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EBM Subcourse – Main
Components
EBM REVIEW Session
Setting: large classroom with at least 1 computer. Students are
encouraged to bring their laptops or iPads.
Time: 1 hour
Preceptors: EBM preceptor and clinician-faculty (generally, clerkship codirectors and sometimes housestaff)
Presentations: Each group reports what they found. The strengths and
weaknesses of the study types are discussed (e.g., randomized control
trials). The students are reminded of resources and worksheets for
critical appraisal both within the institution and publically available.
www.MUSCkids.org
EBM Subcourse
-Supplementary Components
Rounds with the EBM Preceptor Present
Rounds for at least 1 morning with each of the student ward teams
• at MUSC: 6 different teams of 3-4 students
• Afternoon office hours for students to finish working on
questions
ADVANTAGES: EBM preceptor’s presence encourages clinical
questions and EBM discussion (these questions are in addition to
the EBM Finale questions)
DIFFICULTIES: No EBM Preceptor. One solution might be to
have the attending decide one day per week to focus on EBM .
www.MUSCkids.org
EBM Subcourse
-Supplementary Components
Resident EBM Conferences
WHICH STUDENTS ATTEND: the students on the
hospitalist service/general pediatrics wards (10-12
students are on the wards at a time)
• The curriculum is set for the residency program
which runs over 3 years, and so the students on any
given block or rotation only receive a sample of what
the residents are being taught. The sessions vary.
• ** It is very important for the students to see the
residents modelling a positive attitude towards and
behaviors with EBM.
www.MUSCkids.org
EBM Subcourse
-- Main
Components
EBM FINALE
Student Preparation:
Support is provided throughout the clerkship (Clerkship Orientation,
EBM Review, Clerkship Midpoint Feedback, Rounds with EBM
Preceptor, EBM Preceptor Office Hours).
Work in their ward teams (6 groups of 3-4 students)
Clinical Setting: generally, the clinical questions arise on general
pediatric ward rounds.
Approval of the Question and Search Strategy: must have their
clinical question, PICO/PICOTT question and their search strategy
approved by the EBM preceptor before the EBM Finale project is
due.
Due Date: the presentation outline or slideshow is 1 workday before
the EBM Finale.
www.MUSCkids.org
EBM Subcourse
-- Main
Components
EBM FINALE
PRESENTATION:
15 minutes for each of the 6 teams (90 minutes total)
Setting: classroom with projector/computer
Slideshow presentations are encouraged (the student-audiences
have preferred having visual aids)
Audience: peers, EBM preceptor, clinicians (generally, clerkship codirectors).
Facilitation of the discussion: Faculty members stimulate and
encourage the peer audience members to ask questions.
www.MUSCkids.org
EBM Subcourse
-- Main
Components
EBM FINALE
PRESENTATION:
Content:
• Summary of the clinical scenario and the clinical question
• PICO/PICOTT question
• Demonstration of their search in whichever database they used
(e.g., PubMed) and discussion of the search strategy, terms and
limits.
• Description of their chosen article and how they chose their
article.
• Demonstration/discussion of a statistical method/test
• Discussion of the relevance of their the article to their
patient’s care and their own future practice. Description of the
care actually delivered to their patient and the rationale.
Participation: Each student in the group must take an active and
speaking role at this EBM Finale.
www.MUSCkids.org
EBM Subcourse
-- Main
Components
EBM Finale: Example of Active Learning
ED-5-A
A medical education program must include instructional
opportunities for active learning and independent study to foster
the skills necessary for lifelong learning.
– Assess their learning needs, individually or in groups
– Identify, analyze, and synthesize information relevant to their
learning needs
– Assess the credibility of information sources
– Share the information with their peers and supervisors
http://www.lcme.org/connections/connections_2013-2014/ED-5-A_2013-2014.htm
www.MUSCkids.org
EBM Subcourse -- Main
Components
EBM FINALE:
Evaluation (the EBM Finale is a relatively safe environment because
the EBM Preceptor’s approval was required before the presentation
for clinical and PICO/PICOTT question and literature search
strategy)
By Faculty: verbal and written comments (see form)
By Peers: more difficult, evolving
• problem 1 : students are reluctant to give anything but positive
comments (with rare exception, students assign perfect scores to
their peers)
• Problem 2: students focus their comments on the slideshow
appearance and ignore other aspects
• Problem 3: students do not seem eager to review evaluations for
their own team
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EBM Subcourse
-- Student
Feedback
Purpose of 12 question E*Value Survey: to elicit medical student
perspective on EBM Subcourse.
When: Fall of 2013
Who: all 167 fourth-year students were sent a 12-question E*Value survey
How: 12 question E* Value Survey. Insitutional Review Board approval
obtained. Descriptive statistics were generated.
E*Value (https://www.e-value.net/home-main.cfm)
www.MUSCkids.org
EBM Subcourse-- Student
Feedback
Did the Pediatric Clerkship EBM Subcource prepare you for your future? (N=160)
Mean
Disagree/
(scale 1-5,
Strongly
Not
5 is
Undecided Strongly
Agree/Agree
applicable
Disagree
Strongly
Agree)
The EBM training on the Pediatric
Clerkship prepared me for
residency and my career as a
physician.
109 (68%)
42 (26%)
7 (4%)
2(1%)
3.77
I have applied what I have learned
about EBM on the Pediatric
Clerkship in other clinical settings.
113 (71%)
31(19%)
14(9%)
2(1%)
3.75
www.MUSCkids.org
EBM Subcourse
-- Student
Feedback
Aspects of your EBM training during the Pediatric Clerkship which were most useful to you
(select up to 3) (N=160)
N
% of all answers
Total responses
345
100%
EBM Review
79
23
EBM Finale
72
21
Ward rounds with librarian
77
22
Afternoon sessions with librarian
49
14
Noon sessions/Resident EBM sessions
68
20
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EBM Subcourse
-- Student
Feedback
Suggestions to improve EBM training on the pediatric clerkship (select up to 3) (N=160).
N
% of all
answers
Total answers
258
100%
Having a faculty and resident audience for the EBM Finale
31
12
More paper clinical cases to work through
36
14
More assignments to research clinical questions on my patients during the wards 56
22
More assignments to research clinical questions on my patients during the
nursery
More assignments to research clinical questions on my patients during the
outpatient clinics
16
6
23
9
More assignments to research clinical questions on my patients during the ED
17
7
More emphasis on humanism through the EBM training
22
9
None of these
57
22
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EBM Subcourse--Future
Develop a more effective peer evaluation
system.
Explore how the students are applying their
skills in clinical settings subsequent to our
EBM Subcourse.
Standardize the critical appraisal aspect of
the EBM Finale (? Appraisal worksheet).
www.MUSCkids.org
EBM Subcourse-- Does It
Translate to Other Settings?
Smaller clerkships with individual projects
Larger clerkships/remote-site learners
EBM Review assignments electronically, MUSC pilot
Teleconferencing
Lifelong skills
www.MUSCkids.org
Coomarasamy, A., & Khan, K. S. (2004). What is the evidence that
postgraduate teaching in evidence based medicine changes anything?
A systematic review. BMJ (Clinical Research Ed.), 329(7473), 1017.
doi:329/7473/1017
Council on Medical Student Education in Pediatrics. (2012).
Curriculum competencies and objectives. Retrieved from
https://www.comsep.org/curriculum/curriculumcompetencies/prefac
e.cfm
Ilic, D., & Maloney, S. (2014). Methods of teaching medical trainees
evidence-based medicine: A systematic review. Medical Education,
48(2), 124-135. doi:10.1111/medu.12288 [doi]
Liaison Committee on Medical Education (LCME). (2014). 2013-14:
ED-5-A. Educational program for the MD degree. Retrieved from
http://www.lcme.org/connections/connections_2013-2014/ED-5A_2013-2014.htm
www.MUSCkids.org