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Should We Be Teaching Information Management Instead of Evidence-based Medicine?

  • Symposium: ABJS Carl T. Brighton Workshop on Health Informatics
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward in many regards, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine and surgery. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients and be valid.

Where are we now?

Today, orthopaedic surgery is in the post-Flexner era of passive didactic learning combined with the practical experience of surgery as taught by supervising experts. The medical student and house officer fill their memory with mountains of facts and classic references ‘just in case’ that information is needed. With libraries and now internet repositories of orthopaedic information, all orthopaedic knowledge can be readily accessed without having to store much in one’s memory. Evidence is often trumped by the opinion of a teacher or expert in the field.

Where do we need to go?

To improve the quality of orthopaedic surgery there should be application of the best evidence, changing practice where needed when evidence is available. To apply evidence, the evidence has to find a way into practice without the long pipeline of change that now exists. Evidence should trump opinion and unfounded practices.

How do we get there?

To create a curriculum and learning space for information management requires effort on the part of medical schools, residency programs and health systems. Internet sources need to be created that have the readily available evidence-based answers to patient issues so surgeons do not need to spend all the time necessary to research the questions on their own. Information management is built on a platform created by EBM but saves the surgeon time and improves accuracy by having experts validate the evidence and make it easily available.

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References

  1. ACGME Outcomes Project, General competencies. Available at: http://www.acgme.org/outcome/comp/compFull.asp. Accessed November 12, 2009.

  2. American Board of Medical Specialties Maintenance of Certification. Available at: http://www.abms.org/MOC.asp. Accessed November 18, 2009.

  3. Carter BS, Leuthner S. Decision making in the NICU—strategies, statistics and “satisficing.” Bioethics Forum. 2002;18:7–15.

    PubMed  Google Scholar 

  4. Cassel EJ. Diagnosing suffering: a perspective. Ann Intern Med. 1999;131:531–534.

    Google Scholar 

  5. Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306:639–645.

    CAS  PubMed  Google Scholar 

  6. Center for Information Mastery, University of Virginia. Available at: http://www.healthsystem.virginia.edu/internet/familymed/docs/info_mastery.cfm. Accessed November 18, 2009.

  7. Chueh H, Barnett GO. “Just-in-time” clinical information. Acad Med. 1997;72:512–517.

    CAS  PubMed  Google Scholar 

  8. Committee on Quality Health Care in American, Institute of Medicine. Crossing the Quality Chasm: A New Health System for The 21 st Century. Washington, DC: National Academy Press; 2001:5–6.

  9. Curley SP, Connelly DP, Rich ED. Physicians’ use of medical knowledge resources: preliminary theoretical framework and findings. Med Decis Making. 1990;10:231–241.

    CAS  PubMed  Google Scholar 

  10. Curley SP, Yates JF, Young MJ. Seeking and applying diagnostic information in a health care setting. Acta Psychol (Amst). 1990;73:211–223.

    CAS  Google Scholar 

  11. Dynamed. Available at: http://www.dynamicmedical.com. Accessed November 29, 2009.

  12. Ebell MH, Shaughnessy AF. Information mastery: integrating continuing medical education with the information needs of clinicians. J Cont Ed Health Prof. 2003;23:S53–S62.

    Google Scholar 

  13. Ebell MH, Siwek J, Weiss BD, Woolf SH, Susman J, Ewigman B, Bowman M. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004;69:548–556.

    PubMed  Google Scholar 

  14. Ely JW, Osheroff JA, Ebell MH, Bergus GR, Levy BT, Chambliss ML. Analysis of questions asked by family doctors regarding patient care. BMJ. 1999;319:358–361.

    CAS  PubMed  Google Scholar 

  15. Gigernenzer G, Todd PM. Simple Heuristics That Make Us Smart. New York, NY: Oxford University Press; 1999.

    Google Scholar 

  16. Grad R, Macaulay AC, Warner M. Teaching evidence-based medical care: description and evaluation. Fam Med. 2001;33:602–606.

    CAS  PubMed  Google Scholar 

  17. Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met? Am J Med. 2000;109:218–223.

    CAS  PubMed  Google Scholar 

  18. Helwig AL, Flynn D. Using palmtop computers to improve students’ evidence-based decision making. Acad Med. 1998;73:603–604.

    CAS  PubMed  Google Scholar 

  19. Hurwitz SR, Slawson DA, Shaughnessy A. Orthopaedic information mastery: applying evidence-based information tools to improve patient outcome while saving orthopaedists’ time. J Bone Joint Surg Am. 2000;82:888–895.

    CAS  PubMed  Google Scholar 

  20. InfoPOEMs, Inc. Available at: http://www.InfoPOEMs.com/. Accessed November 18, 2009.

  21. Johnston JM, Leung, GM, Tin KY, Ho LM, Lam R. Evaluation of handheld clinical decision support tool for evidence-based learning and practice in medical undergraduates. Med Educ. 2004;38:628–637.

    PubMed  Google Scholar 

  22. JournalWatch Online. Available at: http://www.jwatch.org/. Accessed November 18, 2009.

  23. Leung GM, Johnston JM, Tin KY, Wong IOL, Ho LM, Lam TH. A cluster randomized trial of clinical decision support tools to improve evidence-based medicine learning in medical students. BMJ. 2003;327:1090.

    PubMed  Google Scholar 

  24. McColl A, Smith H, White P, Field J. General practitioners’ perceptions of the route to evidence-based medicine: a questionnaire survey. BMJ. 1998;316:361–365.

    CAS  PubMed  Google Scholar 

  25. Menzel H. Sociological perspectives on the information-gathering practices of the scientific investigator and the medical practitioner. In: McCord D, ed. Bibliotheca Medica: Physician for Tomorrow. Boston, MA: Harvard Medical School; 1966:127–128.

    Google Scholar 

  26. Orthopaedic Web Links. Available at: www.orthopaedicweblinks.com/news. Accessed November 30, 2009.

  27. Oxford Center for Evidence-Based Medicine. Levels of evidence and grades of recommendation. Available at: http://www.cebm.net/levels_of_evidence.asp. Accessed November 30, 2009.

  28. Oxman AD, Sackett DL, Guyatt GH. Users’ guides to the medical literature. I. How to get started. JAMA. 1993;270:2093–2095.

    CAS  PubMed  Google Scholar 

  29. Putnam W, Twohig PL, Burge FI, Jackson LA, Cox JL. A qualitative study of evidence in primary care: what the practitioners are saying. CMAJ. 2002;166:1525–1530.

    PubMed  Google Scholar 

  30. Riordan FAI, Boyle EM, Phillips B. Best paediatric evidence: is it accessible and used on-call? Arch Dis Child. 2004;89:469–471.

    CAS  PubMed  Google Scholar 

  31. Rosser WW, Slawson DC, Shaughnessy AF. Information Mastery: Evidence-Based Family Medicine. 2nd ed. Hamilton, Ontario, Canada: Decker Inc; 2004.

    Google Scholar 

  32. Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the “evidence cart.” JAMA. 1998;280:1336–1338.

    CAS  PubMed  Google Scholar 

  33. Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. How to Practice and Teach EBM. New York, NY: Churchill Livingstone; 2000:3–6.

  34. Schilling LM, Steiner JF, Lundahl K, Anderson RJ. Residents’ patient-specific clinical questions: opportunities for evidence-based learning. Acad Med. 2005;80:51–56.

    PubMed  Google Scholar 

  35. Schon DA. The Reflective Practitioner. How Professionals Think in Action. New York, NY: Basic Books; 1983:42.

    Google Scholar 

  36. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical Evidence of Bias- Subverting randomization in controlled trials. JAMA. 1995;273:408–412.

    CAS  PubMed  Google Scholar 

  37. Schulz, KF, Grimes DA. Allocation concealment in randomized trials: defending against deciphering. Lancet. 2002;359:614–618.

    PubMed  Google Scholar 

  38. Shaughnessy AF, Schlicht JR, Vanscoy GJ, Merenstein JH. Survey and evaluation of newsletters marketed to family physicians. J Am Board Fam Pract. 1992;5:573–579.

    CAS  PubMed  Google Scholar 

  39. Shaughnessy AF, Slawson DC. Are we providing doctors with the training and tools for lifelong learning? Interview by Abi Berger. BMJ. 1999;319:1280.

    CAS  PubMed  Google Scholar 

  40. Shaughnessy AF, Slawson DC. What happened to the valid POEMs? A survey of review articles on the treatment of type 2 diabetes. BMI. 2003;327:266–269.

    Google Scholar 

  41. Shaughnessy AF, Slawson DC, Bennett JH. Becoming an information master: a guidebook to the medical information jungle. J Fam Pract. 1994;39:489–499.

    CAS  PubMed  Google Scholar 

  42. Simon HA. Models of Man, Social and Rational: Mathematical Essays on Rational Human Behavior in a Social Setting. New York, NY: Wiley; 1957.

    Google Scholar 

  43. Slawson DC, Shaughnessy AF. Teaching evidence based medicine: should we be teaching information management instead? Acad Med. 2005;80:685–689.

    PubMed  Google Scholar 

  44. Slawson DC, Shaughnessy AF. Teaching information mastery: creating informed consumers of medical information. J Am Board Fam Pract. 1999.12:444–449.

    CAS  PubMed  Google Scholar 

  45. Slawson DC, Shaughnessy AF, Barry J. Which should come first: rigor or relevance? J Fam Pract. 2001;50:209–210.

    CAS  PubMed  Google Scholar 

  46. Sloane PA, Brazier H, Murphy AW, Collins T. Evidence based medicine in clinical practice: how to advise patients on the influence of age on outcome of surgical anterior cruciate ligament reconstruction: a review of the literature. Br J Sports Med. 2002;36:200–203.

    CAS  PubMed  Google Scholar 

  47. Smith R. What information do doctors need? BMJ. 1996;313:1062–1067.

    CAS  PubMed  Google Scholar 

  48. Steward M, Brown JB, Weston WW, McWhinney ML, McWilliam CL, Freeman TR. Patient-Centered Medicine. Transforming the Clinical Method. Thousand Oaks, CA: Sage Publications; 1995.

    Google Scholar 

Download references

Acknowledgments

We thank Dr. Shaughnessy, Pharm D. for his contributions to related work on teaching Information Management and for support of this presentation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, NC, 27599-7055, USA

    Shepard R. Hurwitz MD

  2. University of Virginia School of Medicine, Charlottesville, VA, USA

    David C. Slawson MD

Authors
  1. Shepard R. Hurwitz MD
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  2. David C. Slawson MD
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Corresponding author

Correspondence to Shepard R. Hurwitz MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Dr. Slawson is a paid consultant for Wiley & Son publisher.

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Hurwitz, S.R., Slawson, D.C. Should We Be Teaching Information Management Instead of Evidence-based Medicine?. Clin Orthop Relat Res 468, 2633–2639 (2010). https://doi.org/10.1007/s11999-010-1381-x

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  • DOI: https://doi.org/10.1007/s11999-010-1381-x

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