Evidence-BasedEmergency Medicine

Denver Health Medical Center Residency in Emergency Medicine

Denver, Colorado

The Way It Was• Once upon a time…

– Research methods were taught using a conventional didactic structure

– “Journal Club” used publications as an applied approach to supplement our understanding of research and its potential application to our clinical practice (while attempting to teach the assessment of methodological quality)

The Way It Was• Unfortunately…

– Formal didactics provided once or twice each year provide little advancement in the understanding of critical appraisal and important methodological concepts

– “Journal Club” was not sufficiently developed or structured to provide a conceptual framework by which to evaluate medical literature and integrate it into clinical practice

The Way It Was• And…

– Research methods didactics and “Journal Club” were insufficiency integrated

• This resulted in…– Relatively poor understanding of how to

identify the appropriate medical literature, which of it was important, why it was important, and how it might be integrated into clinical practice

Goals of EBEM• To improve how we integrate empiric

evidence (research) into clinical practice

• By teaching how to…– Ask– Search– Critique– Integrate

What’s Different?• The didactic curriculum is gone (sort of)

• “Journal Club” is also gone

• Both have now been integrated into the following “Evidence-Based Emergency Medicine” curriculum

What’s Different?• Logistical Aspects

– Held every month (12 per year)– Last 1.5 hours of first Wednesday conference– Modeled using a progressive curriculum– Specific curriculum faculty

The EBEM Team• Emmy Betz, MD, MPH• Richard Byyny, MD, MSc• Adit Ginde, MD, MPH• Jason Haukoos, MD, MSc• Kennon Heard, MD• Eric Lavonas, MD• Mike Liao, MD• Steve Lowenstein, MD, MPH• Jody Vogel, MD• Stephen Wolf, MD

What Else Is Different?• Applied Aspects

– Mostly active learning– Attempts to mimic actual clinical practice– Requires a higher level of participation

• Interactive• Bi-directional open discussion• Expect to be engaged• Required participation outside monthly meetings

Two Residents

Present a “Classic” EM Article or High Impact

Article

Present Search Strategies

Present Articles

Ask the Next Question

45 M

inut

es20

Min

utes

20 M

inut

es

EBEM Faculty

The Group

Brief Methods Lecture

Structured Templates Focused Methods Questions

What Happens Between Meetings?

• Assigned residents and faculty…– Perform systematic search– Identify the “best” evidence for presentation– Develop presentation

• How the search was performed• Formal brief presentation of each article• Critique of methodology (using standardized

templates)• Presentation and discussion of methodology

“pearls”

What Happens Between Meetings?

• And everyone else…– Receive and read each article– Apply the template to each article– Receive methods questions for each article– Consider each question and attempt to

answer them– Prepare to participate in open discussion

about each article

And Yes, There’s More

• “Classic EM” Articles– Original research only– Provide the opportunity to become familiar

with research that has impacted our practice (usually highly cited or “big impact” articles)

– Distributed weekly by email– Brief description of its “importance”– Articles may be significantly qualified

In The End• Expect to be able to…

– Ask better clinical questions– Identify the most relevant evidence– Critique the research and understand its

validity (or lack thereof)– Make decisions about integrating the literature

into your practice as an EP– Maintain these skills beyond post-graduate

training