Evidence-Based Pediatrics SIG - Residency Goals



Goals and Objectives for General Pediatric Residency

  • In 2007, the EBP SIG submitted the following goals and objectives to the APA regarding the teaching of EBM to pediatric residents

  • GOAL: Generating Questions. Generate answerable clinical questions.
    • Generate patient-centered clinical questions to support informed decision-making and drive continued knowledge acquisition.
      • Identify at least one area of knowledge deficiency for each patient encounter.
      • Discriminate between those questions that are most important to address during the patient encounter and those that can be addressed after the encounter.
      • Use a standard format to phrase clinical questions (e.g., PICO = Patient/population, Intervention, Comparison Intervention, Outcome) for an efficient literature search.
      • Identify the type of question being asked (e.g., diagnosis, therapy), in order to facilitate retrieval of evidence.

  • GOAL: Retrieving Information. Use information technology to efficiently gather information to support decision making and patient management.
    • Identify the best available information resources to address questions in clinical practice.
      • Conduct a computerized search using OVID, PubMed, or an equivalent search engine to identify original studies addressing the clinical question.
      • Appropriately limit or broaden the search strategy to obtained reasonable number of original studies (e.g., use of Pubmed Clinical Queries to limit)
      • Search for evidence-based summaries of primary articles (e.g., ACP Journal Club, Evidence-Based Medicine, Evidence-Based Child Health)
      • Search for meta-analyses (e.g., Cochrane database of systematic reviews, Rational Clinical Examination, DARE)
      • Retrieve high-quality practice guidelines (e.g., www.guidelines.gov, AAP Practice Guidelines).

  • GOAL: Critical Appraisal. Evaluate the validity of scientific literature.
    • Study design
      • Describe the most common research designs used in clinical, epidemiological, and health services research (e.g., randomized controlled trial, case report, case-control or cohort study, experimental designs)
      • Discuss their strengths and weaknesses of each design. Specifically, compare and contract experimental and observational designs.
      • Explain the importance of a comparison or control group.
      • Identify the ideal study design to address different types of research questions (e.g., Randomized controlled trial for questions of therapy).
      • Describe the importance of randomization.
    • Critically appraise the internal validity of the study methods used. In particular:
      • Describe the difference between allocation concealment and blinding.
      • Describe common sources of bias in clinical research and describe methods used to limit these biases.
      • Describe the influence of “loss to follow up” on study results.
    • Critically appraise the external validity (suitability) of the study. In particular:

      • Assess the spectrum of disease studied in the trial by examining the inclusion and exclusion criteria.
      • Assess the appropriateness of the outcome measure for the study question (e.g. patient-reported outcome measure, surrogate outcome measure).
      • Explain the difference between association and causation. Specifically, list necessary criteria that support a causal relationship (Bradford-Hill criteria: Temporal relationship, strength of association, dose response relationship, consistency between studies, biological plausibility, lack of alternate explanations)
    • Interpret the statistical significance of study results.
      • Explain the meaning of the p value.
      • Interpret the meaning of the 95% confidence interval and explain how this can be used to aid decision making.
      • Discuss the difference between clinical significance and statistical significance.
      • Construct a 2x2 table.
      • Explain the role of sample size on study results (type I and type II error).
    • Assess the clinical significance of study results by examining the effect size.
      • For studies of therapy, calculate and interpret the number needed to treat (NNT). Similarly, for reported adverse events of therapy, calculate the number needed to harm.
      • For studies of diagnosis, calculate and interpret the sensitivity, specificity, positive/negative predictive values, and likelihood ratios.
      • Explain why likelihood ratios are more useful in the clinical context than sensitivity or specificity.
      • Explain how likelihood ratios can be used to obtain the post-test probability and explain how changes in disease prevalence affect thee post-test probabilities.
      • Interpret odds ratios and risk ratios, including those adjusted using multivariable analysis.
      • Interpret the graphical depiction of the results (forest plots) in meta-analyses.

  • GOAL: Applying evidence to patient care.
    • Apply high quality biomedical, epidemiological, and health services research to the daily practice of medicine.
      • Evaluate the overall applicability of new evidence to your patients using:
        • Validity of the evidence
        • Differences between your patient population and the ones studied
        • Clinical judgment and experience
        • Previous literature
        • Relative cost-effectiveness
        • Knowledge of pathophysiology
      • Assess applicability of evidence to your particular patient.
        • Compare your patient’s characteristics to characteristics of patients included in the available studies.
        • Consider other factors which may influence your patient’s outcomes (e.g., comorbid conditions, lack of transportation).
      • Discuss evidence with patients (or their guardians)
        • Elicit patient values regarding available evidence.
        • Collaborate with patients in developing a mutually acceptable management plan using available evidence.
      • Efficiently discuss evidence with colleagues using the Critically Appraised Topic format.

  • Goal: Understand the broader context of research
    • Explain the ethics of research activities, including subject recruitment, informed consent solicitation, patient privacy assurance. Describe the role of Institutional Review Boards, and Data Safety Monitoring Boards.
    • Weigh the risks and benefits on industry-sponsored research.

  • Goal: Information management; ongoing review of the literature for evidence that is relevant, valid, and impacts patient care.
    • Use ‘foraging tools’ (e.g., journal watch, subscription to receive table of contents from relevant journal, BMJplus) to keep up with new developments in the medical literature.
    • Quickly distinguish information that is relevant to clinical practice from information which is not clinically useful, not practical, or not valid.
    • Use information technology to support patient education and patient care decisions.
      • Use internet sites to obtain reliable patient education materials.
      • Explore new developments in the application of technology to the practice of medicine (e.g., telemedicine, medical-decision making, computerized medical records and electronic information network)
    • Reflect on your own success at practicing the steps of evidence-based practice as outlined above.

 

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