Should We Be Teaching Information Management Instead of Evidence-based Medicine?
- 233 Downloads
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.
KeywordsInformation Management Valid Information Information Tool Busy Clinical Practice Hunting Tool
We thank Dr. Shaughnessy, Pharm D. for his contributions to related work on teaching Information Management and for support of this presentation.
- 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.
- 4.Cassel EJ. Diagnosing suffering: a perspective. Ann Intern Med. 1999;131:531–534.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.
- 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.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.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
- 15.Gigernenzer G, Todd PM. Simple Heuristics That Make Us Smart. New York, NY: Oxford University Press; 1999.Google Scholar
- 20.InfoPOEMs, Inc. Available at: http://www.InfoPOEMs.com/. Accessed November 18, 2009.
- 22.JournalWatch Online. Available at: http://www.jwatch.org/. Accessed November 18, 2009.
- 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.
- 31.Rosser WW, Slawson DC, Shaughnessy AF. Information Mastery: Evidence-Based Family Medicine. 2nd ed. Hamilton, Ontario, Canada: Decker Inc; 2004.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.Google Scholar
- 35.Schon DA. The Reflective Practitioner. How Professionals Think in Action. New York, NY: Basic Books; 1983:42.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
- 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
- 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