Reflection: Evidence Based Medicine

This was definitely a jam-packed week of statistics and critical appraisal. It was very valuable to have the opportunities to not only learn about the different critical appraisal tools, but also apply and use it for patient cases. Even with the time allotted for us to use the tools, I was not able to finish going over the entire checklist and was able to truly appreciate how long a full and comprehensive critical appraisal can take. The big thing that most of our presenters emphasized was the need to practice, practice practice before you can expect to be efficient in this skill. As residency progresses, I aim to refine this skill as I prepare for my future journal clubs, project and literature searches.

 

Some points that I took away were:

  • Make evidence synopses! Always question the evidence of what you are recommending or counselling (e.g. no alcohol while taking antibiotics — this belief actually came about because people were dying from STIs and they were still infective while taking ab treatment, and alcohol increased the likelihood they would have more intercourse)
    • Cochrane reviews: as unbiased as you can get, but still have bias
    • Search: drug name meta-analysis systematic review, RCTs
  • Even if it is a small study where SS cannot be achieved (e.g. pilot studies), statistics can still be used to tell you about variance, mean, population size
  • Talking to patients about evidence
    1. Set the stage (WOW Intro: Who you are, Occupation, Why you are here)
    2. Use Framing language
    3. Understand the Patient’s Experience and Expectations
    4. Build partnerships
    5. Explain disease
    *Why they were at risk
    *Disease and symptoms
    *Impact of having that disease and complications
    6. Explain medications
    7. Provide Evidence on Benefit and Risk
    (Benefits, Risks, Characteristics)
    8. Elicit patient’s benefits, values and preferences
    9. Discuss a shared recommendation
    10. Check for understanding and agreement
    11. Talk about follow-up

Helpful Resources:

 

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2 thoughts on “Reflection: Evidence Based Medicine

  1. Hi Shermaine: I just wanted to comment on your point…. “Even if it is a small study where SS cannot be achieved (e.g. pilot studies)….” I wanted to comment that there is a difference between a pilot study and a study in which SS is too small. A pilot study is deliberately small, to work out the logistics, feasability of the methodology, etc. It is ethical to only expose a small group of patients to this, until you know that the study can be done. Studies that don’t enroll enough patients to be statistically significant, in my mind, are poorly conducted and in some ways a waste of time and money because you can’t really conclude anything from them. To call them “pilot studies” is a mis-nomer
    Feel free to discuss this with better EBM experts than I, if the opportunity arises…if you find other info or opinions, please share.

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    • Hi Alison: I had asked one of the facilitators about the type of statistics that could be done for a descriptive study like my project which has a relatively small sample size and may not be powered to show any SS. He had brought up pilot studies in his answers and I mistakenly grouped it together with a study in which the size is too small to reach SS. Thank you very much for clarifying on this point! It was very helpful.

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