Teaching EBM? You can sim that!

In Education & Quality Improvement, Infographics by Isabelle GrayLeave a Comment

If you’re in medicine, you’ve probably had to sit through at least one literature searching session. You were probably introduced to a long list of acronyms (most of which you’ve long forgotten) representing different literature databases. Perhaps you were asked to try out a search strategy in some of these databases, which you carefully assembled line by line.

Did you ever wonder what the goal of these sessions were? Not sufficiently in depth to conduct a systematic review (definitely involve your friendly neighbourhood librarian for those!), but too cumbersome to use while working in the busy ED. In fact, a study of “EBM consults” – where trained off-shift residents answered clinical questions from on-shift ED attendings – resulted in no change in residents’ practice.​1​ This isn’t surprising given the average consult took nearly 40 minutes to complete.

Educators face the challenge of making evidence based medicine (EBM) exciting and interesting. At our institution, we brainstormed ways to make the literature searching session more engaging, relevant and applicable to ED practice – and came up with something novel that worked.​2​

First, we flipped the classroom and gave residents pre-readings on how to conduct a search strategy as well as a brief list of the most ED relevant databases/resources, including tips for searching each one on a smartphone (see Appendix A)​1​. Next we ran residents through a high fidelity simulation case where they were put on the spot to find evidence for a therapeutic intervention. From the start of the search to calling out a clinical decision took less than five minutes.

The goal of our simulation was to encourage residents to use resources that offer a “smarter” and more efficient search (spoiler alert: a widely used subscription-based app – many people’s go-to – wasn’t especially helpful for this exercise!). This is done by either using pre-appraised resources to identify primary literature, or by conducting a more focused search of ED-relevant primary literature. Nine months later, residents searched for literature at the bedside more frequently than they did before the session.

Of course, point-of-care literature searching must happen in the right context: patients who are acutely unstable need prompt treatment. However, many of our ED patients are stable enough to wait the five minutes it takes to make an evidence-informed decision. As residents learn to effectively search resources and to find evidence they trust, more patients will benefit from ED physicians bringing EBM to the bedside.

Read more about our study here!

This post was copyedited by Alvin Chin.

References

  1. 1.
    Friedman S, Sayers B, Lazio M, Friedman S, Gisondi MA. Curriculum Design of a Case-based Knowledge Translation Shift for Emergency Medicine Residents. Academic Emergency Medicine. Published online October 2010:S42-S48. doi:10.1111/j.1553-2712.2010.00879.x
  2. 2.
    Colmers‐Gray IN, Ha DJ, Tan MC, Dong SL. Evidence‐based Medicine Simulation: A Novel and Practice‐relevant Approach to Teaching Real‐time Literature Searching to Emergency Medicine Residents. Cico SJ, ed. AEM Education and Training. Published online February 28, 2020:428-432. doi:10.1002/aet2.10437

Isabelle Gray

Izzy is an Assistant Professor in Emergency Medicine at Queen's University in Kingston. Her interests include medical education, evidence-based medicine and research. When not working, studying or running after her children, she can be found adventuring in the mountains. No conflicts of interest.

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Sandy Dong

Dr. Sandy Dong is the RCPC Emergency Medicine Residency Program Director at the University of Alberta and emergency physician at the Royal Alexandra & University of Alberta Hospitals and the Northeast Community Health Centre in Edmonton, Alberta.

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