Minimal Criteria for Approving Evidence-Based Medicine (EBM) Courses for the Resident by the Saudi Council of Health Specialties

This document is prepared for the Saudi Council for Health Specialties (SCHS) to decide the standards that should be fulfilled by any center that aims to conduct a training course on Evidence Based Medicine (EBM). This is essential before being approved by the SCHS.

Duration 3 days

Either three days course or 2 ½ days course + one half day assessment
Seven Hours/day

Human and other resources

A. Human Resources
One trainer (Instructor) per 8 candidates or less.
All trainers should have attended a basic EBM course and preferably "teaching the teachers" course.
It is preferably if one trainer or librarian attended a course on searching or has sufficient searching skills.
Twelve candidates or less per group (small group teaching)

B. Other arrangements and resources
One computer with live internet connection per two candidates or less.
The material should be sent for candidates at least one week before the course.
A space enough for small group discussion and OSCE examination if performed
Access or subscription to some or all of the following databases: Cochrane Library, PubMed, CLINICAL EVIDENCE, Evidence Based Medicine, ACP Journal Club, trip database, Up to date, SUM Search, and GACGUIDELINES.

Learning Outcomes

At the end of the course, the candidates should have been familiar to the following competencies, which are based on the five steps of EBM.
Translation of uncertainty in to an answerable question. The student identifies knowledge gaps during the course of practice and asks foreground questions to fill these gaps. The student should ask focused questions that lead to effective search and appraisal strategies.
Search for and retrieval of evidence. The student can design and conduct a search strategy to answer questions. The student understands the strengths and weaknesses of the different sources of evidence.
Critical appraisal of evidence for validity and clinical importance. The student can appraise the validity of a study. The appraisal will include: the suitability of the type of study to the type of question asked, the reliability of outcome measures chosen, and the suitability and robustness of the analysis employed. The student can appraise the importance of the outcomes and translate them into clinically meaningful summary statistics, such as number needed to treat (NNT). The course should cover the therapy, diagnosis, and systematic review (Meta analysis) studies.
Application of appraised evidence to practice. The student can assess the relevance of the appraised evidence to the need that prompted the question. The student can explore the patient's values and the acceptability of the answer.
Evaluation of performance. After the student had asked the focused question(s), searched sources of evidence, appraised or used pre-appraised evidence and applied these in practice, (S)he would reflect on how well these activities were performed.

Process of teaching

Process of teaching
EBM Steps	No. of Hours
	Theory
Translation of uncertainty into an answerable question.	2
Search for and retrieval of evidence.	4
Critical appraisal of evidence for validity and clinical importance.	9
Application of appraised evidence to practice.	3
Evaluation of performance.	3

It should be noticed that at least 60% of each of the steps allocated time should be in the form of practical (either hands on or small groups discussions) and not more than 40% on the didactic sessions (theory).

Methods of Teaching

It is advisable to follow the following guidelines for the process of teaching. They are arranged in the sequence of the EBM steps:
Translation of uncertainty in to an answerable question.
Presenting clinical scenarios or asking candidates to share a problem encountered in their clinical practice. Framing a focused, answerable question in a structured format(2). Several formats are taught: 3 part (patient-intervention/exposure-comparator-outcome), or 5 part (patient-intervention/exposure- comparator-outcome-time) questions.
Search for and retrieval of evidence.
Theoretical instruction backed by a supervised practical session (hands-on medical websites search)) with online connection(3). A librarian with search skills could be utilized for this purpose if possible. A variety of databases should be shown as possible with the strengths and weaknesses discussed. Examples include Cochrane Library, PubMed, CLINICAL EVIDENCE, Evidence Based Medicine, Upto date, ACP Journal Club, trip database, SUM Search and GACGUIDELINES but Minimal two are required: one primary unfiltered website (e.g. PubMed) and one secondary filtered one (e.g. cochrane library)
Critical appraisal of evidence for validity and clinical importance.
This is probably the most widely taught skill [5] Examples include the Critical Appraisals Skills Program(4).
Application of appraised evidence to practice.
Examples include applying the identified evidence to the specific context that led to the quest for evidence. This requires exploration of the generalisability of the evidence to the specific scenario, and 'particularizing outcomes by adjusting for patient-specific risks (5).
Evaluation of performance
Role modeling by the attending senior physicians and /or EBP teachers. The encouragement of adult learning styles and Journal clubs(6).

Assessment (Optional)

While the majority of the group agreed on the benefit of evaluating the workshops by the participants. However it was agreed that, for the time being, the formative assessment is optional. The benefits of formative assessments are a lot including feedback to the teachers and course organizers and feedback to the participants on their strong and weak points.
Computer based OSCE has been used elsewhere to test the abilities of framing questions, searching, and retrieving appropriate evidence(8).

The assessment for each EBM step is as follow:

1	One or more station covering step 1: Translation of uncertainty into an answerable question as follows: The skills can be assessed by presenting a clinical scenario and asking the student to form a focused, answerable question (included in the Fresno test)(7). This could be done by presenting the question on the screen or in paper and ask the whole group to answer at the same time. One or more question (station) covering step 2 as follows: Search for and retrieval of evidence. This could be done by either giving the search assigned at the end of 2nd day and asking them to bring on the 3rd day or in the form of computer based OSCE One or more station covering step 3 as follows: Critical appraisal of evidence for validity and clinical importance. Tests for critical appraisal of validity including the Fresno test and others, or giving them an article to appraise overnight or during the working day.
2	One or more station covering step 4 as follows: Application of appraised evidence to practice. Objective structured clinical examination (OSCE) involving clinical application and interaction with patient after reading supplied evidence(10).
3	One or more station covering step 5 as follows: Evaluation of performance. Use of a questionnaire to assess knowledge, attitude and behavior(11).
4	Assignment (optional for courses and the participants):- It is a strong educational tool. Each candidate could write a (500-1000) words EBM report. The report describes the experience of the candidate in the application of the five steps of EBM for a clinical question. The candidate should reflect on how well these activities were performed and what conclusions and lessons were learned.

Application Form

You can download the application form for For Conducting EBM WORKSHOP for residents & fellows according to SCHS requirements (ref 1763/3 dated 6/4/1426H) by clicking on the following link:
Application form Mandatory Requirement for EBM Workshops directed to Residents and Fellows:

Registration form

HERE

References
1	Dowes M, Sumnerskill W, Glasziou P, Cartabellota A. et al. Sicily statement on evidence-based practice. BMC Medical Education 2005, 5:1
2	Richardson WS, Wilson MC, Nishikawa J, Hayward RS: The well-built clinical question: a key to evidence-based decisions [editorial]. ACP J Club 1995, 123:A 12-3.
3	Rosenberg WM, Deeks J, Lusher A, Snowball R, Dooley G, Sackett D: Improving searching skills and evidence retrieval. J R Coll Physicians Lond 1998, 32: 557-563.
4	CASP: http:/www.phru.nhs.uk/casp..
5	Straus SE, Sackett DL: Applying evidence to the individual patient. Ann Oncol 1999, 10: 29-32.
6	Sackett DL, Straus S, Richardson WS, Rosenberg W, Haynes B: Evidence-Based Medicine. How to Practice and Teach EBM. Edinburgh, Churchill Livingstone; 2000.
7	Ramos KD, Schafer S, Tracz SM: Validation of the Fresno test of competence in evidence based medicine. BMJ 2003, 326: 19-321.
8	Fliegel JE, Frohna JG, Mangrulkar RS: A computer-based OSCE station to measure competence in evidence-based medicine skills in medical students. Acad Med 2002, 77: 1157-1158.
9	Fritsche L, Greenhalgh T, Falck-Ytter Y, Neumayer HH, Kunz R: Do short courses in evidence based medicine improve knowledge and skills? Validation of Berlin questionnaire and before and after study of courses in evidence based medicine. BMJ 2002, 325: 1338-1341.
10	Bradlley P, Humphris G: Assessing the ability of medical students to apply evidence in practice: the potential of the OSCE. Med Educ 1999, 33: 815-817.
11	Johnston JM, Leung GM, Fielding R, Tin KYK, Ho LM: The development and validation of a knowledge, attitude and behavior questionnaire to assess undergraduate evidence-based practice teaching and learning. Med Edu 2003, 37: 992-1000.