Incorporating Evidence-Based Medicine into Clinical Teaching

How do you integrate scientific evidence into clinical practice and how are you teaching residents to do the same? While your anecdotal experiences are important sources of learning for trainees, it is also critically important to incorporate scientific evidence into your clinical teaching. Evidence-based medicine (EBM) is the conscientious, explicit, and judicious use of current best evidence to guide decision making for individual patients. 
 
We polled some of our most successful on-the-fly EBM educators and residents for their recommendations.

Podcasts IRL
The fact that residents are listening to educational podcasts is overwhelmingly positive – but there is a dark side. When residents want to apply novel therapies and techniques they may have recently heard about on a podcast, consider asking questions that probe for greater depth and understanding of the methods, population, and results of the study that informed the segment. Offer to look at the paper together. You might even consider printing it out and leaving some discussion notes for the oncoming team! 

Pocketful of EBM
When discussing evidence-based patient management, it helps to have articles easily accessible. The longer it takes to log into the library website and find the article you’re looking for, the less likely it is that you’ll actually spend time talking about it. Consider keeping a well-organized folder in Dropbox or Evernote that makes it easy to email or print pdfs.

Decision Rules = Teachable Moments
Residents are often facile with decision rules and pathways but may not know the evidence for or limitations of the tool they’re using. The next time you and your learner are calculating a Well’s score, applying NEXUS or Canadian rules to a trauma patient, or risk-stratifying a patient using the HEART score, take a minute to discuss the evidence (or lack thereof) for utilization of the tool. Pro tip: MDCalc has links to PubMed for relevant articles and validation studies. Just scroll past the score and click the “Evidence” button.

Following Up
Did you see a patient with a diagnosis the resident or student had never heard of? Perhaps you want to drive home a point about the evidence for the management of common (or not so common) condition. Consider emailing an article to your learner after the shift for some relevant follow up education. This strategy creates spaced repetition of the important content, which helps make learning memorable. 

Mini Journal Club
Have a recent must-read article you want to share? Bring it in and discuss the importance and any take-aways that you want learners to have for a few minutes at the beginning of the shift.