Teaching Residents to Follow the Evidence

“There’s a lot of information out there, and with access the internet provides, it’s easy to get confused on what information to use,” said Lyon, who serves as board chair of the Family Physicians Inquiries Network. “Physicians have to know what to believe and what to trust. It is important to understand how to critically appraise the literature by understanding levels of evidence and validity of what you’re reading, which will assist you in determining how to use this new knowledge in medical decision-making.”

Lyon trained in the family medicine residency program at the naval hospital in Jacksonville, Fla., before spending three years as a full-scope family physician at a naval hospital in Italy. Returning to the United States as a civilian, Lyon joined the faculty at the Research Family Medicine Residency Program in Kansas City, Mo., in 2007. There he was asked to revamp the curriculum related to evidence-based medicine, critical appraisal and scholarly work. The Accreditation Council for Graduate Medical Education requires family medicine residents to participate in at least two scholarly projects, so Lyon worked to fill the gaps.

“If you’re going to ask residents to complete a scholarly project, they have to have a foundation of knowledge in evidence-based medicine that they can use to develop something scholarly,” Lyon said.

Before starting a project, Lyon develops a series of workshops for residents that cover issues like evidence-based medicine components, statistical analysis and critical appraisal skills.

“The scholarly project is part of a bigger, evidence-based curriculum,” Lyon said. “The goal isn’t the project, it’s being able to understand and implement evidence-based medicine to make decisions.”

In 2011, Lyon became an associate professor and associate program director at the University of Colorado Family Medicine Residency program and brought with him his process of mentoring residents and helping them publish their research. Lyon has authored or co-authored more than 50 articles related to his own work in peer-reviewed journals, and he also has served as a co-author on nearly 40 resident projects in Evidence-Based Practice since 2008. Now he’s mentoring other faculty to do the same.

“I understand there’s a good chance that the only time they might publish is when they are in residency because they’re going to go into practice and become busy family medicine doctors with panels of patients,” said Lyon, who also is associate vice chair for clinical affairs in the Department of Family Medicine at the University of Colorado School of Medicine. “Working to put their skills into motion is really rewarding. It’s an honor to be part of it when residents get published.”

Lyon said writing “wasn’t my thing” in medical school or residency, but as he honed this skill, his peers took note. He has served as editor of three different Family Physicians Inquiries Network writing projects: HelpDesk Answers, Priority Updates from the Research Literature and Good Evidence Matters.

The network was created through an AAFP grant in 1990 to increase scholarly uptake and output by family physicians. Over time it has evolved into a nonprofit membership organization offering scholarship, education and professional development opportunities to students, residents, faculty and fellows in family medicine residency programs.

Good Evidence Matters is a new writing project for residents or faculty who are new to the critical appraisal and publication process, and it can serve as a first step for authors. As their scholarly writing skills grow, they can contribute to HelpDesk Answers, which provides evidence-based answers to clinical questions in Evidence-Based Practice.

Lyon said FPIN provided his first opportunity to do national work in family medicine and led to other opportunities. He now is a member of the Colorado AFP Board of Directors and serves on the AAFP’s Commission on Health of the Public and Science. He also serves on the editorial board of Family Practice Management and multiple ABFM committees.

“The more you’re in that environment, the more you meet amazing leaders in family medicine, which leads to other opportunities,” he said.