New Directions:Honoring Our Learners

Closing Advice from Our Wise ‘Elders’

• John• Bob• Barry• Jason• Beau• Steven

Closing Advice from Others in Our Midst

Closing Advice from me …

• Patients & Clinical Problems

• Role-Models, Coaches, Mentors

• Increasingly a Team Sport

• Consciousness

• Risk-Taker

Core Principles ofEvidence-Based Medicine

1. The better the research evidence, the more confident our clinical decisions

2. Evidence alone is never sufficient to make clinical decisions

This Feels Complicated … Do We All Need Advanced EBCP Skills?

A) ‘Evidence-Based Practitioners’• Adept at using the entire evidence-based cycle• Advanced critical appraisal skills; can use original

literature if needed• Can be leaders

B) ‘Evidence Users’• Have appreciation for strong evidence• Can seek out and use pre-appraised summaries

Guyatt, BMJ 2000; 320:954-5

Consider …

Aiming to steadily get further in your skills.There are great tools & resources to help you.

Ultimately, You have to decide what to aim for …

1.Evidence-based practitioner (a.k.a. enthusiast) with broad capabilities

2.Evidence User with focused abilities to use pre-appraised evidence-based summaries

Chat with your Neighbor …

• How are these 3 terms different:– Role Modeling– Coaching– Mentoring

• Will solicit in 2 minutes

How They Different?

• Role-Modeling

• Coaching

• Mentoring

Important & Distinct Roles

Role-Model• Passive, observational mode … you try to

emulate

Coach• Time-limited relationship• Teaches & directs; Drives specific agenda • Focused on improving performance of specific

skills/tasks

Important & Distinct Roles

• Mentor• Developmental relationship

• Active listener

• Facilitates without agenda

• ‘The process whereby an experienced, highly-regarded, empathic person (the mentor) guides another – usually younger – individual (the mentee) in the development and re-examination of their own ideas, learning, and personal & professional development.’

J. Oxley, Mentoring for Doctors

Team Player & Multiplier (Wiseman, 2010)

Shifting EBCP Enthusiast Focus

Zen YodaHarried Novice

Staying conscious

Ericsson, Acad Med 2004; 79:S70-81

Please Stand Up …

Remain standing if you’ve:

• Crossed a street against Don’t Walk sign

• Eaten real (raw) sushi

• Traveled to a third world country

• Eaten from a street vendor there

• Jumped out of a perfectly fine airplane

Looking for ‘Role Models’

• We need you to embrace being a ‘risk taker’

• ‘Models’ try to make clear some features of a complex issue … they aren’t perfect, just simplified representations

• ‘Role Modeling’ needn’t wait for mastery, perfect systems of care, or idealized educational settings

Kenny, Acad Med 2003

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Treatment Threshold

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Clinical Action Thresholds(Critical to Clinicians)

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EBCP Action Thresholds(Critical to EBM Teachers)

Teaching Threshold

Practice Threshold

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EBCP Teachers & Situations

Teaching Threshold

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Teaching Threshold

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EBCP Teachers & Situations

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EBCP Teachers & Situations

Teaching Threshold

Practice Threshold

Closing Advice from me …

• Patients & Clinical Problems

• Role-Models, Coaches, Mentors

• Increasingly a Team Sport

• Consciousness

• Risk-Taker

• Do Right by Learners & Patients