Strand Descriptor
Title: Evidence and Decisions
Principal Section:
Tayside Centre for General Practice, Community Health Sciences
Course:
Doctors Patients and Communities
Learning needs Identified:
A new qualified doctor needs to know how to find the evidence to inform their practice and be aware of the different forms of evidence there is. They need
to know how to assess the relevance and the quality in relation to patient population on an individual and community level.
They also need to have the skills of clinical reasoning and to be able to use evidence to help them make decisions.
Aim of the evidence and decisions strand
To produce a student who knows how to search for evidence and where to find it. The student should have an understanding of basic statistics. They should
be able to appraise the evidence and use it when giving advice to a patient.
Scottish Doctor Learning outcome
Level 1
Level 2
What the doctor is
able to do
1. Outcomes for
Clinical skills
Level 3
Level 4 and DPaC Learning aims/outcomes and competences
Take a history from
patients relatives and
others
Undertake physical and
mental state
examinations of patients
By the end of year 3 the student should:
 Have used the data gathered from a written patient history in a
clinical reasoning process
By the end of year 3 the student should:
 Have used the findings described from a physical and mental state
examinations in case scenario in a clinical reasoning process
Make a diagnosis
3. Patient investigation
General principles of
patient investigation
5. Outcomes for
Disease Prevention and
health promotion
Demonstrate the ability
to implement , where
appropriate, risk
reduction strategies for
individual patients
Accessing data sources
7. Outcomes for
medical informatics
IT Skills / Computing skills
How the doctor
approaches their
practice
8 Outcomes for Basic,
Social and Clinical
Sciences
10. Outcomes for
decision making skills,
and clinical reasoning
and judgement
Public health
Evidence based medicine
By the end of year 3 the student should:
 Have analysed all available information in a clinical scenario to
help make a differential diagnosis
By the end of year 3 the student should:
 Have discussed how clinical reasoning informs the choice of clinical
investigations for a patient
By the end of year 3 the student should be able to:
 provide evidence-based advice on MMR vaccination
 describe the current evidence on the link between MMR and
autism
By the end of year 2 the student should:
 Have used library and on-line information sources, including
internet and intranet systems accurately, systematically and in
sufficient depth.
 Acknowledged that there are databases, for example Medline,
Cochrane, on-line journals, etc and an awareness of how to use the
 Used information in evidence-based practice
 Identified professional guidelines
By the end of year 1 the student should:
 Demonstrate an ability to understand and use published research
data
By the end of year 2 the student should:
 know how to seek the best available evidence
Know how to analyse and interpret evidence and work with
guidelines and protocols.
 Realise the importance of adopting an inquisitive and questioning
attitude and applying rational processes.
appreciate the importance of own value judgments and those of
patients
 Appreciate the importance of making decisions in partnership with
colleagues and patients in relation to video work.
 Know why it is essential for a doctor to use the most recent, high
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quality research in his or her clinical practice.
Know the importance of asking a clear question when looking for
research evidence to support clinical decisions.
Appreciate that the quality of research is highly variable.
Know the concept of bias.
Apply basic critical appraisal to avoid using poor quality,
unimportant or irrelevant research.
Recognise the most common ways of presenting treatment effects
and understand that the way effects are communicated affects
how they are interpreted.
Know how to think and communicate quantitatively.
By the end of year 3 the student should:
 Apply the skills to seek the best available evidence
 Apply the skills to analyse and interpret evidence
 Recognise the limitations of EBM
 Demonstrate knowledge and appreciation of quantitative
methodology.
 Apply research and scientific methodologies to interpret
investigations.
 Demonstrate how to think and communicate quantitatively.
 Appreciate that uncertainty exists and that sources of uncertainty
might include oneself, the environment, the patient, limits of
knowledge.
 Appreciate the importance of making decisions in partnership with
colleagues and patients.
 Understand why it is essential for a doctor to use the most recent,
high quality research in his or her clinical practice.
 Appreciate that the quality of research is highly variable.
 Further develop critical appraisal skills so to avoid using poor
quality, unimportant or irrelevant research.
 Discuss and interpret the most common ways of presenting
treatment effects and use this information to inform in clinical
Clinical reasoning
Evidence-based medicine
Critical thinking
decision-making.
 Realise the importance of adopting an inquisitive and questioning
attitude and applying rational processes
 Be able to discussed the quality of a study in patient terms
By the end of year 2 the student should:
 Know how to analyse and interpret information and cope with
limitations of information and personal limitations.
Know how to seek the best available evidence and keep up to date
By the end of year 3 the student should:
 recognize a problem in a case scenario and defined it
 Have analysed and interpreted information in cases scenarios
 recognize that information can be limited
 Have applied hypothetical deductive reasoning to a clinical
scenario
 Have discussed the importance of pattern recognition
 Have discussed the importance of using schemata
By the end of year 2 the student should:
 appreciate and recognise the role of evidence in practice
 identify sources of evidence
 recognise the need to assess evidence
 apply the principles of searching for evidence
 critically appraise evidence
Discussed how evidence can be used during the consultation
By the end of year 3 the student should:
 discussed the importance of applying rational processes to
decision making
 discussed the importance of adopting a questioning attitude when
considering alternative options to a decision
Content
Patient centered Medicine: Transforming the clinical method Moira Stewart
Principles of immunisation and published papers on the MMR vaccine
Chest pain, shortness of breath, and difficulty walking core clinical problems
Organisation
The content is delivered:
 In the study guide,
 Through small group work with DPaC tutors and peers.
 Independent research
 Through studying case scenarios
 In lectures
Educational strategy
This is a mixture of student centred and teacher centred approach.
Put information regarding websites and references into study guides and on Blackboard
Use of independent research
Lectures used to give some core content
Teaching strategy
Critically appraising published articles
Sharing information with colleagues
Reflection on the information gained
Discussion and analyses of case scenarios
Consultation with a simulated patient and peer appraisal with feedback
Analyses of a consultation with colleagues
Assessment
Formative during small group sessions for module 1.1.4a, 2.4.5, 2.4.8, 3.5.5, 3.5.0000 and 3.5.8
Part of attitudes assessment for modules, 2.4.8,
Peer appraisal for modules 2.4.8 and 3.5.8
Exam questions for modules 2.4.5, 3.5.5, and 3.5.0000
Written assignment for module 3.5.4a
DVD work 2.4.8
Immunisation 3.5.4a and DVD work 3.5.8
Clinical reasoning 3.5.0000
Associated Modules
Drugs/alcohol and the first stage of critical appraisal 1.1.4a
Searching for the evidence 2.1.00
Evidence informed healthcare 2.4.5
DVD work 2.4.8
Immunisation 3.5.4a
Evidence informed healthcare 3.5.5
Clinical reasoning 3.5.0000
DVD work 3.5.8