Thanks Dr. Viderveld for joining us today. I was wondering if I could ask you, how do you approach teaching evidence-based medicine to learners on the inpatient wards? >> Absolutely. So, when I am seeing patients on my own and rounding on my own, evidence-based medicine is part of my daily process, and so I naturally try to make that part of our daily routines when we're rounding with students and residents. So on rounds, we often have clinical questions that arise, students asking why we're doing what we're doing, or the team talking about what the best next diagnostic or therapeutic thing is to do for the patient. And so while we're in the room, we'll talk about what our question is, and I'll encourage learners to go to the literature to try to find guidance on answering those questions. So in the room we often have the question, is pretty naturally comes up as a PICO question, just as clinical questions often do that. But if they have learners having a difficult time defining the question then I'll go through who is the patient that we're trying to discuss here, trying to find answers on, what intervention are we looking at, what comparisons do we want to look for and what outcomes are we going to be measuring. >> Great. >> And then, as we leave the room, we'll talk about how they might go about looking at those things as we're walking to the next patient to try to make things efficient on daily rounds. So we'll talk about where to find evidence based medicine. Now I often encouraged them to look at clinical practice guidelines or Cochrane reviews or other review. Ways of looking at this, looking for these questions. But I also encourage them to go to Ovid or PubMed to look at original research as well especially if there aren't to clinical practice guidelines available, and then we talked about what they found in the afternoon after rounds. So after rounds they're able to go and do their work and look these things up. And now has come back to talk to the team in the afternoon. And afternoons we'll start by talking about what it is that they found. And then we'll talk about the article itself and how the research was done. And then we'll talk about how that actually applies to our patient. And if it's really applicable to our patient. And based whether discussion is then we'll make our clinical plan for our patient, and finalize our clinical plan for the patient. It's my goal that these students make this a part of their daily routine, and they don't necessarily even have to think about EBM. They have a clinical question, they go to literature to answer, to get guidance and then are easily able to apply that to their patient. >> So it seems like it's very efficient to come up with the question on rounds and then later on in the afternoon, giving them some time in the meantime to come up with the answer to the question. >> Yes. Yes. >> What challenges do you find that the learners have? >> So I think that sometimes they have a difficult time just finding research. And so we talk sometimes about making sure that we've defined our question properly. And then also about what search terms they're using, and where they're searching to try to help them find articles, and then at the end, when we're going through questions or articles that they've gotten. Sometimes they have a difficult time just appraising the article itself, and so we go through how you do that. >> Okay, great. And I know that you're very involved in generating clinical practice guidelines for our institution. How you go about getting learners involved in that process? >> So we talk about how clinical practice guidelines are generated, and I talk about that with students, so that they know the process. So the first part of the process is obviously defining what you want to look at, and defining your problem. And guidelines are great for something where you have a lot of practice variation or where it's not clear what the next steps are. And so finding those topics so for instance, right now we're starting to develop hyperbilirubinemia guidelines for neonates. >> Great. >> And that came about because there's a lot of variation in how people go about diagnosing and treating Hyperprolinemia and neonates. So after you've defined your problem, the next step is actually to define your patient population, and who is inclusive and who's going to be included in the guideline and who you would exclude from the guideline. And then you actually go through an outline, what you're looking at. And in the outline, you'll come up with various questions about diagnostics and what steps to do next and as well as therapeutics, and prevention. And after you've done that you assemble a team of experts in those areas. And you divide the work up to look at the different evidence behind these questions that you've come up with. We usually will start with a sentinel article or if there is a previous guideline available. So for instance has an American Academy of Pediatrics guideline that is currently in existence. And so we'll often start with that as a starting point, and then look at any evidence that's been published since that time. And as we go through and each individual writer is looking at their questions and their evidence, they have to appraise the articles. And so they look at the articles and look at what level of evidence they're able to obtain from these articles, and then they'll write small paragraphs of recommendations based on those. >> Sounds like a great way of incorporating evidence based medicine into the clinical practice. >> It is. >> Well thank you very much, I appreciate your time. >> Thank you.
