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MUSC Excellence at the College of Medicine/UMA

Program looks at evidence-based medicine

by Jerry Reves, M.D.
Dean, College of Medicine and Vice President, Medical Affairs
As we enter a new academic year, I would like to take this opportunity to highlight a successful, novel education model that should prove valuable to many leaders within our college, both clinical and non-clinical. During the past three years, the Department of Pediatrics has implemented an intensive program to instruct residents on the principles and practices of evidence-based medicine (EBM). The genesis and evolution of this program, under the leadership of department chair Lyndon Key, M.D., has led to recent national attention.
Initial pediatric EBM program efforts included the development of a series of core lectures for residents by faculty, followed by weekly presentations by interns and residents. Using feedback from faculty and residents, the program’s format was restructured in the second year, such that in the first half of the academic year, each session consists of a second-year resident’s brief presentation of a common pediatric problem—such as otitis media, seizures, or asthma—followed by an intern’s discussion of a structured EBM question linked to that condition. This process includes formulating a question, searching for the best evidence for treatment, performing a critical appraisal of that evidence, and presenting the material in PowerPoint format in a noon conference setting.  The presentation then leads to a discussion of how that evidence impacts clinical practice. In the second half of the year, interns continue to present evidence related to questions derived from actual clinical settings they have encountered. Second-year residents begin to work on a capstone research project and continue to function as teachers, while third-year residents complete their research projects, to be presented or published by the end of residency. House officers participate in high numbers at the weekly EBM conferences.
Third-year residents and their faculty mentors submitted abstracts of EBM research projects to the recent Pediatric Academic Societies annual meeting. These included Drs. Cameron Anderson and Schyler Mims reporting on the frequency of lactation failure in very low birthweight infants with Dr. Carol Wagner; Drs. Ted Brenkert and Kate Herwig examining the outcomes of enema-reduced intussusception with Dr. Joe Losek; Drs. Heather Saavedra and Tish Shanley evaluating gastrostomy tube care in the pediatric emergency department with Dr. Olivia Titus; Drs. Andrea Preston, Dave Mills, and Priya Raman reporting on adherence to asthma treatment guidelines among hospitalized children with Dr. Ron Teufel; and Drs. Rita Chen, Sanjiv Pasala, and Mike Oltmann evaluating outcomes of peripherally inserted central catheters with Dr. Sandra Fowler.
Reference librarian Laura Cousineau joined the EBM faculty in its first year, and along with Dr. Sandra Fowler, is now co-director of the pediatric EBM program. Unique features of the program include a “resident-powered” approach, in which upper level residents act as teachers for the interns; hands-on application of EBM skills in real clinical settings; the inclusion of a librarian as a core faculty member; use of WebCT, an online course management software tool, to archive presentations and to post additional resources and links; and the requirement for an evidence-based research project during residency. Dr. Fowler and Ms. Cousineau both presented posters about the pediatric EBM program at the recent Association of Pediatric Program Directors meeting.
The Department of Pediatrics’ innovative approach to resident learning could be used throughout the college and country. Please join me in recognizing this outstanding example of “excellence in action.”

Friday, Aug. 15, 2008
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