using a teach the teacher-program to implement a new ebm · pdf file · 2012-11-141...
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Using a Teach the Teacher-program to implement a new EBM-based teaching
method for residents and staff members
T. van Kempen MSc., Prof. Dr. P.J. Dörr,
Prof. dr. F.W. Dekker
Center for Innovation in Medical Education
LUMC
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Je n’ai aucune affiliation
(financière ou autre) avec une
entreprise pharmaceutique, un
fabricant d’appareils médicaux
ou un cabinet de
communication.
I do not have an affiliation
(financial or otherwise) with
a pharmaceutical, medical
device or communications
organization.
Author: Tanja van Kempen MSc.
Date: oct/11/2012
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Tanja van Kempen MSc.
Educationalist
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overview
• Background
• What is a CAT?
• The problem
• Our solution
• Result
• Pros/cons
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Background
• CanMEDS in the Netherlands
2011
• role of scholar: the CAT was made
compulsory
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Do you know what a CAT is?
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Do you know what a CAT is?
• A Critically Appraised Topic (CAT) is a
practical tool for learning and applying
critical appraisal skills1,2
• EBM3
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CAT4
1. Patient encounter
2. Clinical question
3. Literature search
4. Critical appraisal
5. Summarising evidence
6. Commentary
7. Bottom line www.mediview.org
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CATs in education5
Undergraduate training programme
Clinicians
Postgraduate training programme
• concise and
connect theory to
practice
• self-teaching tool
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The question
• How can we implement this new
educational tool in the Leiden area?
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The problem
• The CAT was a completely new method
• We had a large number of residents who
had to be trained
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Our Solution
• Train the staff members in a Teach the
Teacher
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literature
• Role modeling is a powerful tool in EBM6
• Doctors often seem to have a lack of
knowledge about EBM terms, but the
majority wanted to know more about
EBM7
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The solution
• We developed a 2 day Teach the Teacher-
program for so-called CAT tutors
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Aims for the TtT
• Introduce the 7 step method
• Increase knowledge and skills
• Provide didactical background
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Teach the Teacher
Trainers
3 epidemiologists
1 pediatric cardiologist
1 clinical librarian
1 educationalist
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Teach the Teacher
Participants
Different specialists
from the whole
region
Minimal EBM skills
required
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Patient (practice) transition Medical science (literature)
1 clinical scenario
2 clinical question 3 literature search
4 critical appraisal
5 summarising
evidence 6 comments:
Thorough reflection on
the evidence
7 bottom line
Key words
TtT day 1
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Patient (practice) transition Medical science (literature)
1 clinical scenario
2 clinical question 3 literature search
4 critical appraisal
5 summarising
evidence 6 comments:
Thorough reflection on
the evidence
7 bottom line
Key words
TtT day 2
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Results
We evaluated the TtT in two ways
• immediate
• after 6 months
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Results after training
overall appreciation
N=37
M=4
Dev=0.5
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Results after training
relevance
N=38
M=4.2
Dev=0.5
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Results after training
combination of
literature and practice
N=38
M=3.9
Dev=0.7
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Results after training
active learning style
N=39
M=4
Dev=0.6
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Results after training
quality of the trainers
N=38
M=4.3
Dev=0.6
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Results after training
time investement
N=39
M=3.9
Dev=0.6
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Results after training
aims of the course are
reached
N=39
M=3.9
Dev=0.6
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Results after training
I am going to use some
aspects in practice
N=37
M=4.4
Dev=0.5
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Results after 6 months
I am using the course mainly for my own
work – I learned a lot! At this time I don’t
have any residents.
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Results after 6 months
The training was very good but its hard to
find time in our busy schedule to guide the
residents (25!) and let them present their
CATs.
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Results after 6 months
I am now more confident that I can help my
residents – those 7 steps where
completely new for me.
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Pros and Cons
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Pros of using a TtT for
implementing the CAT
• Important to include staffmembers in education
reform
• Updating skills and knowledge from staffmembers
• Education in EBM should be workplace related
• Many departments can be helped at the same
time
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Cons of using a TtT for
implementing the CAT
• It is impossible to foresee all the local problems
staffmembers encounter while introducing the
CAT in their department
• Sometimes it is difficult for staffmembers to
‘teach’ their colleagues
• The implementation depends on one
staffmember, if he/she doesn’t prioritise the
CAT, nobody will.
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Q & A
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literature
1 Dawes M. (2005) Critically appraised topics and evidence-based medicine journals. Singapore Med
J. 46:442-448;quiz, 449
2 Sauve S., Lee HN., Meade MD.m et al. (1995) The critically appraised topic: a practical approach to
learning critical appraisal. Ann Roy Soc Phys Surg Can 28:396-398
3 Kelly, A.M., Cronin, P. (2011) How to perform a critically appraised topic: Part 1, ask, search and
apply. AJR: 197 November 2011
4 Brouwer, de C. P.M. Training Critical Appraisal of a Topic. ISBN: 978-90-77201-31-2
5 Wiebe S. & Demaerschalk B. (2002) Evidence based care in the neuroschiences. Can J. Neurol.
Sci. 29: 115-119
6 Sacket et al. in Aiyer, M.K. & Dorsch, J.L. (2008) The transformation of an EBM curriculum: a 10-
year experience. Medical Teacher 30:377-383
7 Oliveri, R.S. Gluud, C. & Wille-Jorgensen, P.A. (2004) Hospital docters’self-rated skills in and use of
evidence-based medicine. J Evaluation in Clinical Practice 10, 2: 219-226
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• Teaching critical appraisal skills to health
professionals improves knowledge but
there is a lack of evidence that it changes
the process of care of patient outcomes.
There are large gaps in the evidence
(Cochrane review 2010)