Project description:BACKGROUND: Clinical prediction rules (CPR) are tools that clinicians can use to predict the most likely diagnosis, prognosis, or response to treatment in a patient based on individual characteristics. CPRs attempt to standardize, simplify, and increase the accuracy of clinicians' diagnostic and prognostic assessments. The teaching tips series is designed to give teachers advice and materials they can use to attain specific educational objectives. EDUCATIONAL OBJECTIVES: In this article, we present 3 teaching tips aimed at helping clinical learners use clinical prediction rules and to more accurately assess pretest probability in every day practice. The first tip is designed to demonstrate variability in physician estimation of pretest probability. The second tip demonstrates how the estimate of pretest probability influences the interpretation of diagnostic tests and patient management. The third tip exposes learners to various examples and different types of Clinical Prediction Rules (CPR) and how to apply them in practice. PILOT TESTING: We field tested all 3 tips with 16 learners, a mix of interns and senior residents. Teacher preparatory time was approximately 2 hours. The field test utilized a board and a data projector; 3 handouts were prepared. The tips were felt to be clear and the educational objectives reached. Potential teaching pitfalls were identified. CONCLUSION: Teaching with these tips will help physicians appreciate the importance of applying evidence to their every day decisions. In 2 or 3 short teaching sessions, clinicians can also become familiar with the use of CPRs in applying evidence consistently in everyday practice.

| S-EPMC2517969 | biostudies-other

Tips for teachers of evidence-based medicine: making sense of decision analysis using a decision tree.

Project description:Decision analysis is a tool that clinicians can use to choose an option that maximizes the overall net benefit to a patient. It is an explicit, quantitative, and systematic approach to decision making under conditions of uncertainty. In this article, we present two teaching tips aimed at helping clinical learners understand the use and relevance of decision analysis. The first tip demonstrates the structure of a decision tree. With this tree, a clinician may identify the optimal choice among complicated options by calculating probabilities of events and incorporating patient valuations of possible outcomes. The second tip demonstrates how to address uncertainty regarding the estimates used in a decision tree. We field tested the tips twice with interns and senior residents. Teacher preparatory time was approximately 90 minutes. The field test utilized a board and a calculator. Two handouts were prepared. Learners identified the importance of incorporating values into the decision-making process as well as the role of uncertainty. The educational objectives appeared to be reached. These teaching tips introduce clinical learners to decision analysis in a fashion aimed to illustrate principles of clinical reasoning and how patient values can be actively incorporated into complex decision making.

| S-EPMC2669856 | biostudies-other

Tips for teachers of evidence-based medicine: adjusting for prognostic imbalances (confounding variables) in studies on therapy or harm.

Project description: Not available

| S-EPMC2253654 | biostudies-literature

Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat.

Project description: Not available

| S-EPMC509050 | biostudies-literature

Tips for learners of evidence-based medicine: 2. Measures of precision (confidence intervals).

Project description: Not available

| S-EPMC516199 | biostudies-literature

Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic).

Project description: Not available

| S-EPMC527344 | biostudies-literature

Overestimation of risk ratios by odds ratios in trials and cohort studies: alternatives to logistic regression.

Project description: Not available

| S-EPMC3348192 | biostudies-literature

Measuring additive interaction using odds ratios.

Project description:Interaction measured on the additive scale has been argued to be better correlated with biologic interaction than when measured on the multiplicative scale. Measures of interaction on the additive scale have been developed using risk ratios. However, in studies that use odds ratios as the sole measure of effect, the calculation of these measures of additive interaction is usually performed by directly substituting odds ratios for risk ratios. Yet assessing additive interaction based on replacing risk ratios by odds ratios in formulas that were derived using the former may be erroneous. In this paper, we evaluate the extent to which three measures of additive interaction - the interaction contrast ratio (ICR), the attributable proportion due to interaction (AP), and the synergy index (S), estimated using odds ratios versus using risk ratios differ as the incidence of the outcome of interest increases in the source population and/or as the magnitude of interaction increases. Our analysis shows that the difference between the two depends on the measure of interaction used, the type of interaction present, and the baseline incidence of the outcome. Substituting odds ratios for risk ratios, when calculating measures of additive interaction, may result in misleading conclusions. Of the three measures, AP appears to be the most robust to this direct substitution. Formulas that use stratum specific odds and odds ratios to accurately calculate measures of additive interaction are presented.

| S-EPMC1475799 | biostudies-other

How are "teaching the teachers" courses in evidence based medicine evaluated? A systematic review.

Project description:BackgroundTeaching of evidence-based medicine (EBM) has become widespread in medical education. Teaching the teachers (TTT) courses address the increased teaching demand and the need to improve effectiveness of EBM teaching. We conducted a systematic review of assessment tools for EBM TTT courses. To summarise and appraise existing assessment methods for teaching the teachers courses in EBM by a systematic review.MethodsWe searched PubMed, BioMed, EmBase, Cochrane and Eric databases without language restrictions and included articles that assessed its participants. Study selection and data extraction were conducted independently by two reviewers.ResultsOf 1230 potentially relevant studies, five papers met the selection criteria. There were no specific assessment tools for evaluating effectiveness of EBM TTT courses. Some of the material available might be useful in initiating the development of such an assessment tool.ConclusionThere is a need for the development of educationally sound assessment tools for teaching the teachers courses in EBM, without which it would be impossible to ascertain if such courses have the desired effect.

| S-EPMC2958160 | biostudies-literature

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