Evidence-based medicine among internal medicine residents in a community hospital program using smart phones

Abstract Background Few studies have examined residents' retained knowledge and confidence regarding essential evidence-based medicine (EBM) topics. Objective To compare postgraduate year-3 (PGY-3) residents' confidence with EBM topics taught during internship with that of PGY-1 residents before and after exposure to an EBM curriculum. Methods All residents participated in an EBM curriculum during their intern year. We surveyed residents in 2009. PGY-1 residents completed a Likert-scale type survey (which included questions from the validated Berlin questionnaire and others, developed based on input from local EBM experts). We administered the Berlin questionnaire to a subset of PGY-3 residents. Results Forty-five PGY-3 (88%; n = 51) and 42 PGY-1 (91%; n = 46) residents completed the survey. Compared with PGY-1 residents pre-curriculum, PGY-3 residents were significantly more confident in their knowledge of pre- and posttest probability (mean difference, 1.14; P = .002), number needed to harm (mean difference, 1.09; P = .002), likelihood ratio (mean difference, 1.01; P = .003), formulation of a focused clinical question (mean difference, 0.98; P = .001), and critical appraisal of therapy articles (mean difference, 0.91; P = .002). Perceived confidence was significantly lower for PGY-3 than post-curriculum PGY-1 residents on relative risk (mean difference, −0.86; P = .002), study design for prognosis questions (mean difference, −0.75; P = .004), number needed to harm (mean difference, −0.67; P = .01), ability to critically appraise systematic reviews (mean difference, −0.65, P = .009), and retrieval of evidence (mean difference, −0.56; P = .008), among others. There was no relationship between confidence with and actual knowledge of EBM topics. Conclusions Our findings demonstrate lower confidence among PGY-3 than among PGY-1 internal medicine residents for several EBM topics. PGY-3 residents demonstrated poor knowledge of several core topics taught during internship. Longitudinal EBM curricula throughout residency may help reinforce residents' EBM knowledge and their confidence.

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Internal medicine, complexity, evidence based medicine, almost ‘‘without evidences’’

Italian Journal of Medicine ◽

10.4081/itjm.2009.191 ◽

2013 ◽

pp. 191-200

Author(s):

Roberto Nardi ◽

Tatiana Fabbri ◽

Gelorma Belmonte ◽

Paolo Leandri ◽

Magda Mazzetti ◽

...

Keyword(s):

Internal Medicine ◽

Evidence Based Medicine ◽

Models Of Care ◽

Evidence Based ◽

Suitable Alternative ◽

The Real ◽

Economic Problems ◽

Clinic Management ◽

Individualised Care ◽

Based Medicine

Background: Internal medicine has been defined as the specialty of the adult medical complex patients. Complexity science suggests that illness (and health) results from complex, dynamic, and unique interactions between different components of the overall system. In a patient, complexity involves the intricate entanglement of two or more systems (e.g.; body-diseases, family, socioeconomic status, therapies). Aim of the study: To evaluate the real applicability of Evidence Based Medicne (EBM) in clinical Departments of Internal Medicine and its critical perspectives. Discussion: Habitually the internist takes decisions in these situations: a) certainty (the ideal decision is adopted and the corresponding strategy follows), b) risk (the more suitable alternative selected can be the determination of the probable value or mathematical hope) and c) uncertainty, in which decisions linked to triple agents: beliefs and personal values of the doctors (I) for their patients (II) in the society (III). In the medical decisions there are often different factors that go beyond the field of technical and scientific knowledge (family, social, economic problems, etc.) and demanding an ethical analysis of the decision. Conclusions: The ‘‘evidence-based medicine’’, as other models of care, has — in itself — some limitations. ‘‘No evidence in medicine’’ matters that the postulates of the EBM are not always applicable to the real patients of Internal Medicine wards, mostly elderly, frail, complex, with comorbidities and polipharmacy, often with cognitive dysfunction and limitation of autonomy, with psycho-emotional, social and economic problems. The interacting effects of overall involved diseases/factors and their management require more complex and individualised care than simply the sum of separate guideline components. Further innovation is required to resolve the need to enhance integration of evidence with our patients’ values at the ‘‘bedside and/or clinic’’ management.

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Internal medicine - prospect to twenty-first century. II. Advances in related fields and internal medicine and internal medical care. 9. EBM (Evidence-based medicine) and quality of medical care.

Nihon Naika Gakkai Zasshi ◽

10.2169/naika.91.3415 ◽

2002 ◽

Vol 91 (12) ◽

pp. 3415-3420

Author(s):

TSUGUYA FUKUI

Keyword(s):

Internal Medicine ◽

Medical Care ◽

Evidence Based Medicine ◽

First Century ◽

Evidence Based ◽

Quality Of Medical Care ◽

Twenty First Century ◽

Based Medicine

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Methodists

Oxford Research Encyclopedia of Classics ◽

10.1093/acrefore/9780199381135.013.8165 ◽

2017 ◽

Author(s):

Marquis Berrey

Keyword(s):

Internal Medicine ◽

Causal Inference ◽

Medical History ◽

Evidence Based Medicine ◽

Late Antiquity ◽

Evidence Based ◽

Imperial Period ◽

Practice Of Medicine ◽

General Similarity ◽

Based Medicine

Methodists were a self-identified medical sect of the 1st century bce, Imperial period, and late antiquity who shared a common method of observation and causal inference about the practice of medicine. Methodists took their name from the “method” (Gk. methodos), an observable path or evidence-based medicine which the physician undertook to gain secure therapeutic knowledge. The path was supposed to reveal the general similarity between patients’ ostensibly differing conditions. Three similarities, or “commonalities,” as they were called, were possible: fluid, constricted, or a mixture of the two. Opponents pilloried Methodists for the loose logic of their methodological revolution and socially disruptive claims to teach medicine within six months. Primarily a Roman phenomenon, the popularity of Methodism seems to have been due to a ready supply of practitioners and its focus on certain, fast therapy. Methodists wrote chiefly on internal medicine, surgery, and medical history.

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