Evidence-Based Medicine

Evidence alone is never sufficient to make a clinical decision. Clinical decisions also include consideration of benefits and risks of an intervention, inconvenience and costs associated with various management strategies as well as patients values and wishes.

Evidence-Based Medicine (EBM) relies on a hierarchy of evidence to guide clinical decision-making. Along with good clinical skills and strong interpersonal skills (compassion, listening and communication skills), evidence-based medicine skills are one of 3 pillars required for high quality patient care. 

Because of the fundamental importance of EBM skills to clinical practice, the EBM faculty feels that teaching must be regularly integrated into both clinical rotations and the academic curriculum.

You will join a floor team as the designated EBM resident, working closely with an EBM attending, usually the floor team attending. During morning rounds, team members identify one or more patient management issues and formulate structured clinical questions, with your support and feedback.

You’ll search the medical literature to identify relevant publications and assess their validity and results using the Users’ Guide to the Medical Literature’s critical appraisal sheets. During the next rounds meeting (usually that afternoon), you’ll report your findings to the floor team, discuss them together and assist in evidence-based clinical decision-making, integrating the evidence from your research with patients’ values, clinical states and circumstances.

In addition, you will be responsible for conducting two to four interactive small-group sessions. These may be critical appraisal sessions, using the format from the Users’ Guide to the Medical Literature, or didactic sessions to clarify specific concepts.

• finding the evidence
• therapy
• harm
• process of diagnosis
• differential diagnosis
• diagnostic tests
• prognosis
• summarizing the evidence

• moving from evidence to action
• evidence-based practitioners and evidence-based users
• bias and random error
• outcomes of health research
• intention to treat principle
• N of 1 randomized controlled trials
• computer decision support systems
• quality of life
• hypothesis testing
• confidence interval
• measure of association
• applying results to individual patients
• number needed to treat
• surrogate outcomes
• drug class effects
• qualitative research
• clinical manifestations of disease
• measuring agreement beyond chance
• clinical prediction rules
• likelihood rations
• regression and correlation
• publication bias
• fixed effects and random effects models
• evaluating differences in study results
• when to believe a subgroup analysis
• incorporating patient values
• recommendations about screening
• grading recommendations
• economic analysis
• clinical utilization review

• PGY-2, PGY-3 or PGY-4

4 weeks

Determined by your interests and needs.