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Commentary

Tips for learning and teaching evidence-based medicine: introduction to the series

Peter C. Wyer, Sheri Keitz, Rose Hatala, Robert Hayward, Alexandra Barratt, Victor Montori, Eric Wooltorton and Gordon Guyatt
CMAJ August 17, 2004 171 (4) 347-348; DOI: https://doi.org/10.1503/cmaj.1031665
Peter C. Wyer
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Sheri Keitz
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Rose Hatala
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Robert Hayward
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Alexandra Barratt
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Victor Montori
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Eric Wooltorton
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Gordon Guyatt
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  • DIET
    gerry burns
    Posted on: 02 November 2004
  • Practicing is the challenge to teaching EBM
    Harold B Siden
    Posted on: 24 September 2004
  • Posted on: (2 November 2004)
    Page navigation anchor for DIET
    DIET
    • gerry burns

    I read with interest the recent article by Wyers et al, particularly the points about the use of Irbys’ teaching scripts and “easily digestible bites”. I am just finishing a Masters in medical education from a family practice background and my thesis is on this very same topic. I have given it the name of DIET (Disease management Interactive Tool) and it incorporates up to date EBM in teaching chronic disease management to...

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    I read with interest the recent article by Wyers et al, particularly the points about the use of Irbys’ teaching scripts and “easily digestible bites”. I am just finishing a Masters in medical education from a family practice background and my thesis is on this very same topic. I have given it the name of DIET (Disease management Interactive Tool) and it incorporates up to date EBM in teaching chronic disease management to primary care doctors and nurses . There are presentations on such topics as hypertension and diabetes amongst others. DIET makes use of mini lessons or what I call “slide sets” in presenting the EBM but is different from EBM teaching tips which has the ability to be dipped in and out of. Using DIET there is a requirement to present the talk in its entirety which reflects the longitudinal nature of primary care. Another slight difference in the 2 formats is the use of feedback which in DIET is formalised and is in the 3rd slide of each slide set: in teaching tips the feedback is less structured and is implied in the teachers learning script. The specific teaching of particular learning points in the learning script also agrees with Peile et al who discuss the notion of threshold concepts. The notion here is that all subject areas have "threshold concepts," key concepts that, once understood, allow learners to understand, interpret or view something in a different way. Until the threshold is crossed, the student will struggle to progress.

    Overall I think it is going to be a great series and look forward to future editions. Anyone who wants a copy of my teaching scripts please give me an e mail My evaluation of DIET with GPs gave similar results to Dr S K (http://www.cmaj.ca/cgi/data/171/4/353/DC1/1) who scored 8 out of 10 for relevance and usefulness.

    G E Burns

    Peter C. Wyer, Sheri Keitz, Rose Hatala, Robert Hayward, Alexandra Barratt, Victor Montori, Eric Wooltorton, and Gordon Guyatt CMAJ 2004 171: 347 Tips for learning and teaching evidence-based medicine: introduction to the series

    Ed Peile, Colin Macdougall, and Lara McCarthy What the educators are saying BMJ, Mar 2004; 328: 692

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
  • Posted on: (24 September 2004)
    Page navigation anchor for Practicing is the challenge to teaching EBM
    Practicing is the challenge to teaching EBM
    • Harold B Siden, D 606, 4500 Oak Street, Vancouver BC

    To the Editor:

    I am writing to you regarding the new CMAJ series on evidence-based medicine. [Wyer PC, Keitz S, Hatala R, Hayward R, Barratt A, Montori V, et al. Tips for learning and teaching evidence-based medicine: introduction to the series. CMAJ 2004; 171(4):347-8] I applaud your efforts in this regard. As a clinician at at academic institution, and possessor of a Master's Degree in Clinical Epidemiology, I...

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    To the Editor:

    I am writing to you regarding the new CMAJ series on evidence-based medicine. [Wyer PC, Keitz S, Hatala R, Hayward R, Barratt A, Montori V, et al. Tips for learning and teaching evidence-based medicine: introduction to the series. CMAJ 2004; 171(4):347-8] I applaud your efforts in this regard. As a clinician at at academic institution, and possessor of a Master's Degree in Clinical Epidemiology, I am a supporter of the principles of evidence-based medicine (EBM).

    Nevertheless I have found it a challenge to teach EBM primarily because it is a significant challenge to practice EBM. While your series, especially with the "Tips for teachers" component, will go a long way to assisting in the instruction of EBM, unless trainees can use it practically and witness their teachers using it practically, then we will not achieve the goal of having EBM as a core competency of the next generation of physicians.

    Article 1 is an example [Barratt A, Wyer PC, Hatala R, McGinn T, Dans AL, Keitz S, et al, for the Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. CMAJ 2004;171(4):353-8.]. Using Tip 2 on "Balancing benefits and adverse effects in individual patients" requires information on the background risk. This in turn requires efficient access to the types of information cited in the article (references 9 and 10). I think that efficient and effective access to that kind of information in most settings -- either the over-busy hospital ward or the private office -- is a challenge. (I do not say easy access is a problem, because ubiquitous internet connectivity and the plethora of databases make it easy, but not necessarily efficient or effective.)

    In some areas of practice there is information to feed into EBM approaches, such as RCT results, background risks, and other epidemiological data. Cardiovascular and cancer subjects seem to predominate in that literature.

    Those data do not exist however in other specialty fields, such as pediatrics, making it difficult to practice EBM. In the generalist fields such as family medicine the problem is the huge variety of patients, and the constant shift from simple to complex conditions across age groups. To some extent the cardiologists and oncologists have the data at hand as they are dealing with a relatively fixed group of conditions in a specific age group, and where there has been a tremendous amount of population data collected. This is not the situation necessarily ih other specialties or in a general practice.

    I think that the two factors that have hindered adoption of EBM are the challenges of teaching this material, and the challenge of applying it because we often do not have the information required for EBM. Your series will (hopefully) help address the former, but we have not done enough about the latter.

    Sincerely,

    Hal Siden

    H. Siden, MD, MHSc, FRCPC, DABP Clinical Associate Professor Pediatrics, University of British Columbia

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 171 (4)
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Vol. 171, Issue 4
17 Aug 2004
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Tips for learning and teaching evidence-based medicine: introduction to the series
Peter C. Wyer, Sheri Keitz, Rose Hatala, Robert Hayward, Alexandra Barratt, Victor Montori, Eric Wooltorton, Gordon Guyatt
CMAJ Aug 2004, 171 (4) 347-348; DOI: 10.1503/cmaj.1031665

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Tips for learning and teaching evidence-based medicine: introduction to the series
Peter C. Wyer, Sheri Keitz, Rose Hatala, Robert Hayward, Alexandra Barratt, Victor Montori, Eric Wooltorton, Gordon Guyatt
CMAJ Aug 2004, 171 (4) 347-348; DOI: 10.1503/cmaj.1031665
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  • Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat
  • Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic)
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  • Tips for learners of evidence-based medicine: 2. Measures of precision (confidence intervals)
  • Tips for learners of evidence-based medicine: 5. The effect of spectrum of disease on the performance of diagnostic tests
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  • Tips for learners of evidence-based medicine: 4. Assessing heterogeneity of primary studies in systematic reviews and whether to combine their results
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