BY CINDY BORGMEYER
WEB EXTRA! Point-of-care learning:
'Nirvana of needs assessment' 
Do you have what it takes to understand evidence-based medicine and to apply it to your practice? Before you respond, think about the two parts of the question.
The first part involves the ability to independently assess the research evidence on a given clinical issue. The second deals with translating that evidence into practice, with the goal of improving patient care.
The short answer: Yes, you've got what it takes.
Whether they realize it or not, physicians have the requisite knowledge and skills to learn and practice EBM, according to Jack Kues, Ph.D., assistant dean for CME and professor of family medicine at the University of Cincinnati.
Kues and Nancy Davis, Ph.D., director of the AAFP Division of Continuing Medical Education, discussed the respective roles of learners, teachers and CME providers during the 2004 CME Congress held here May 18.
In an increasingly sophisticated research environment, physicians' clinical experience and critical thinking skills form the cornerstone of their ability to integrate EBM concepts into patient care, Kues said. "Learners may not be able to read and understand all the evidence, but they bring these skills to the table, and that's a start."
"Pick out a good clock"
Do learners really need to critically review each new piece of evidence themselves? Certainly not, said EBM guru Allen Shaughnessy, Pharm.D., who sat in on the session.
An adjunct professor of family and community medicine at Penn State College of Medicine, Hershey, and director of medical education for PinnacleHealth System, Harrisburg, Pa., it was Shaughnessy who, along with FP David Slawson, M.D., of Charlottesville, Va., developed the concept of "patient-oriented evidence that matters," or POEMs.
"This equates to a notion that you don't have to be able to build a clock to tell time; it's OK to simply know how to pick out a good clock," Shaughnessy said. "You get to a point where you can say, 'Go out and buy a Swiss army watch.' Quartz movement is good; an atomic clock is better."
In other words, know where to go to get the best evidence.
It's impossible to keep track of all the literature and its implications, said Davis. In a later interview, she discussed how point-of-care evidence summary resources -- such as those listed at http://www.aafp.org/fpr/20040700/6x.htm -- can aid EBM learners.
What's an educator to do?
Kues reviewed the basic tasks confronting CME faculty wanting to incorporate EBM principles into their educational offerings.
First, faculty must identify and assess the available evidence -- all of it. Then, they should develop CME activities around the best evidence. Finally, they must be able to distinguish evidence from opinion.
Although some learners would be satisfied with -- or even prefer -- so-called expert guidance, said Kues, "Do we give learners more fish, or do we send them to www.FishRUs.com?"
Faculty development activities offered by CME providers should focus on teaching educators to actively engage learners, he said. Learners don't need to be spoon-fed; passive learning cuts the likelihood that physicians will actually change their practice behavior.
CME faculty and planners can greatly enhance their chances of successfully reaching -- and teaching -- learners by following a few guidelines, said Kues:
"A lot of learners leave a session thinking it's incredible information," Kues said, "they just have no idea how to apply it."
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
FP Report is published by the
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Copyright © 2004 by
American Academy of Family Physicians.