Project to Enhance Research Literacy (PERL) - Achieving Competency in Evidence Informed Practice: A Resource Guide for Educators

EP6. Demonstrate evidence informed decision-making in clinical care.  

Overview

A key component of evidence informed practice is incorporating the best available research evidence into patient care. While a provider will need to identify a clinical question, locate relevant resources of information, and critically evaluate the information, the EIP process is not complete without applying the relevant evidence in clinical practice1. This competency focuses on determining the applicability of the research to answer the clinical question, incorporating this research evidence into practice, and assessing these decisions through patient health outcomes.

Goal- Determine the applicability of the research to answer the clinical question, incorporating the research evidence into practice, and assessing these decisions through patient health outcomes.  

Learning Objectives

  • Identify resources that facilitate the use of research evidence for clinical problem solving.
  • Synthesize information from multiple resources to make a clinical decision2 .
  • Utilize research evidence, in combination with the patient values and preferences, to inform a care plan.
  • Assess the impact of your decision on health outcomes.

1Competency in EP4 is critical to competency in EP6.
2From the 2013 Accreditation Council for Graduate Medical Education and The American Board of Family Medicine, Family Medicine Milestones.

Resources

Greenhalgh ,T. (2014). How to read a paper: the basics of evidence-based medicine (5th ed.). West Sussex, UK: John Wiley & Sons. ISBN: 978-1-118-80096-6. This book (for purchase) walks the reader through various types of research papers with a focus on critical appraisal.

Guyatt, G., Rennie, D., Meade, M.O., Cook, D.J., (2015). Users' Guides to the Medical Literature. A Manual for Evidence-Based Clinical Practice, 3rd Ed. McGraw-Hill Education. ISBN 978-0-07-179071-0. This book (for purchase) provides a comprehensive overview of evidence based medicine. Chapter 27 reviews various decision making approaches between a provider and patient

Research in Clinical Practice- This freely available self-paced on-line module (listed under section 2) discusses various resources for summary research, how to choose them and a clinical example of applying these resources. If you decide to use this module in your course, please email Dr. Roni Evans (evans972@umn.edu) to track use and receive notification of the most up to date version.

Assessing Older Patients with the Evidence in Mind- A short summary on how students at Palmer College of Chiropractic are taught to integrate evidence based tools into their clinical practice.

DynaMed is a point of care tool that includes pre-appraised evidence based summaries. This service requires a yearly subscription either through an institution or as an individual. A tree trail is available.

PEDro Physiotherapy Evidence Database is a free source of pre-appraised literature often used for chiropractic care.

Natural Medicines Database is a pre-appraised resource for integrative therapies and supplements. This service requires a monthly subscription either through an institution or as an individual.

The University of Western States has created EIP "cue cards" for clinical use. These cards contain concise EIP definitions and tips for applying EIP in clinic.

ABCD FIX: A mnemonic for rapidly checking the quality of an RCT on therapy. Available from the University of Western States, this is a quick way to assess while in the clinic setting.

Classroom Activity

EIP Assignment This document (courtesy of Northwestern Health Sciences University) provides a student worksheet and grading rubric for EIP skills assessment. Additional worksheets from the assignment can be found here. One way to utilize this resource might include a three class series based on a case that the students are observing in clinic. A different portion of the assignment could be discussed and assigned at each class.

Vignette

Sara volunteers at an integrative community clinic. Today she is seeing a new patient that presents with a condition she rarely sees in her practice. It has been several years since she has seen this condition but Sara remembers successful outcomes with an herbal remedy. Sara uses her iPad to check the weight of the research evidence for this remedy in Natural Medicines database. Her search indicates that there is stronger research evidence for a different herbal remedy than what she used last time. Sara then searches PubMed on her iPad and finds a recent RCT that concluded this new remedy is safe and effective. She uses the ABCDFIX mnemonic to get a sense of the study validity. Both the study and the pre-appraised source indicate the newer herbal remedy is effective. Sara discusses this information with the patient and asks the patient how comfortable they are with this approach. The patient expresses some concern over taking the herbs several times a day, one of the drawbacks to this newer herbal remedy. Together they devise a treatment plan that fits with the schedule.