As part of the coursework for PCC, you will participate in a project designed to improve your ability to apply the best available evidence from the medical literature to individual patient care. The Practice-Based Learning Project involves taking knowledge and skills in Evidence-Based Medicine and patient education learned in the first 2 years of medical school and putting them to use in the clinical setting. It has been well received by the students but in the interest of continued course improvement, this year we have made major changes to the project. These changes are in response to feedback from prior students and provide more small group and individualized instruction and guidance throughout the 8 weeks. Much of the project remains independent study and thus you are encouraged to be creative in your development of a Practice-Based Learning Portfolio, which will be the final work product turned in electronically (by email or on disc/CD) for evaluation at the end of the course.

 

Objectives

1. By the end of the rotation, you will demonstrate the ability to generate clinical questions from knowledge gaps identified in the course of patient care.
2. You will demonstrate thorough and efficient search strategies using common databases such as Ovid Medline to find the best available evidence to answer your questions.
3. You will demonstrate critical appraisal of an original study to determine the validity and usefulness of the evidence presented.
4. You will author a summary of the evidence in the form of a critically appraised topic for presentation to your peers.
5. Based on your assessment of a patient education need, you will author a tool to translate needed medical information to a patient population using appropriate reading level and presentation.
6. You will demonstrate the ability to use basic statistics in clinical decision-making.
7. You will find the solution to end world hunger, enable worldwide social justice, and subsequently world peace.

Teaching and Learning Methods

1. Ambulatory clinical teaching. During the course of the 8 weeks you will spend the majority of your time in clinic with your preceptors. Use this time to discuss clinical questions with your preceptor and take any “down time” available to do medline searches, appraise articles, develop ideas for your patient education tool, etc.
2. Wednesday Seminars. Each Wednesday will be spent in seminars on topics related to primary care, including the series on Practice-Based Learning.
3. Small Group Learning. At the beginning of the course you will be divided into 3 small groups which will meet in weeks 3, 5 and 8 for more individualized instruction regarding the Project. You will present your work to your peers in Weeks 5 and 8.
4. Email Help. Your small group leader will be available by email for help with questions throughout the 8 weeks. Keep questions straightforward and replies should return within 48 hours.
5. Independent Study. The old cliché definitely holds true in this project . . . you will get out of it what you put into it. There are many recommended web-based tutorials, books and other resources to help with each part of this project. Please add any other useful resources you find to your Portfolio so that they may be shared with future students.

Evaluation Methods

A Practice-Based Learning Portfolio will be created by each student over the course of the eight weeks. This will be reviewed with the small group preceptor each week and any questions will be answered and individualized tutoring given as needed. The minimum requirements for the contents of the portfolio will be listed but students are encouraged to add as much material to demonstrate their learning as they choose. Other evaluation methods will include pre- and post-testing as well as stations on the final OSCE which test skills and knowledge acquired during this course.

 

Project Timeline

Week 1:  Project Overview and Orientation

Week 3:  Small Group Session #1
Review of questions, search strategies, levels of evidence, and critical appraisal of original article

Week 5:  Small Group Session #2
Critically Appraised Topic Reviews/Problem solving

Week 6:  Clinically Useful Statistics

Week 8:  Small Group Session #3
Critically Appraised Topic and Patient Education Tool Presentations

 

Minimum Contents for Electronic PBL Portfolio and Due Dates

 

Step by Step . . .

Weeks one to three:

1)  Start by reading the tutorial on “How to Get Started”

2)  Practice converting knowledge gaps into PICO format questions.

• Review this brief overview of question formation with example. For in-depth help, review the Asking Clinical Questions tutorial
   
• Worksheets for Portfolio

3)  Use Ovid Medline to search the literature for the highest level of evidence to answer this question.

• Medline searching resources are available at the library (call Cindy Gruwell to set up individualized help), from your small group preceptor, or on various online tutorials.
   
• Review these levels of evidence to determine whether the paper you’ve chosen is indeed at the top.
   
• Read this paper to get an understanding of “methodologic filters” and how they can help you to efficiently find the best evidence.

4)  Critically appraise the article for its validity and usefulness.

• First read the article thoroughly. Use the tutorials found here to learn to read papers on diagnosis, therapy, or prognosis. The EBM Toolkit also has excellent “Users’ Guides” for all types of papers (click on the “Domains” navigation bar for guides for questions on diagnosis, therapy, prognosis, and harm).
   
• Use critical appraisal worksheets to help in the review of your paper. They can be found here: EBM Toolkit or can be downloaded below. If you have chosen a meta-analysis or a systematic review, it is crucial that you go through this tutorial to master the appraisal of this complex type of literature.
   
  1. Therapy Worksheet
  2. Diagnosis Worksheet
  3. Prognosis Worksheet
  4. Harm Worksheet
  5. Systematic Review or Meta-analysis Worksheet

5)  Be prepared with your list of clinical questions, search strategy, and initial choice of your original article for discussion during the small group session of week 3. Bring a copy of the original article as well (this may mean a trip to the library before class! (DO NOT limit your search to only those articles available full text on-line!) Also bring plenty of questions for your preceptor, as the goal of the session will be to work through your questions and examples to help illustrate this process. *NOTE: please coordinate with your other small group members so as not to try to answer the same questions. Review of the posted work of previous students is advised but please don't duplicate this either unless new evidence is found to better answer the question. There are plenty of new questions to go around! (View Examples of Clinical Questions: Example 1, Example 2 and Search Strategies: Example 1, Example 2)

Weeks three to five:

6)  Critically appraise your article (fill out the worksheet in MS Word format to be added to the electronic portfolio), and summarize the evidence in the form of a first draft of your Critically Appraised Topic (CAT). You will be able to address problems and questions during the Week 5 small group session. Lastly, you should solicit ideas from peers on how to convert this into a useful patient education tool. Revisions or complete overhauls may be recommended by your preceptor and peers as needed and should be made to your CAT prior to week 8.

• Use this form as your template for your CAT

Weeks five to eight:

7)  Revisions and suggestions of your first draft of the CAT should be incorporated into the final CAT for presentation during week 8. Now think of how you could educate patients about this information.  Consider the ideas offered by your preceptor and peers in the Week 5 session. If you’d rather not do a patient handout on this topic, think of another patient’s question or information need.   The goal is to help take the information you learn about what is “Best Practice” for patients and help to empower them with this information.  This could take the form of a Patient Education Handout, a Web Based Tutorial, a worksheet a patient could use to calculate their own risk of a disease, a log for patients to keep track of their own preventive care or whatever form you feel would best serve your patient.   Be as creative as you choose but review the following resources regarding patient education materials to ensure they are appropriately focused, simple, and at the right reading level:  Patient Education Website. *NOTE: It is an excellent idea to look at other patient education tools that are available but please come up with your own educational goals for the tool and create your own material!

8)  The completed Portfolio will be due on the Monday of the Week 8 session. This will contain your revised CAT and PET as well as the other materials listed above. Please make sure this has been emailed to Florence Brown by noon of this day. Refer to the table above for all of the due dates for the Portfolio contents.

9)  Be prepared to present your CAT and PET to your preceptor and peers during the Week 8 small group session. The presentation will be a brief overview of the original question, the search strategy, level of evidence, major findings of the critical appraisal, review of the findings of the study, and clinical bottom line. You should include reflection on how this evidence would impact care of future patients. Make sure you bring enough copies of each for everyone.

10)  You've completed the project! Sit back and glow with the satisfaction of a job well done... knowing that the CAT's and PET's you've created will likely be used by your preceptors in clinic for the improvement of their patients' care!