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Using a Teach the Teacher-program to implement a new EBM-based teaching

method for residents and staff members

T. van Kempen MSc., Prof. Dr. P.J. Dörr,

Prof. dr. F.W. Dekker

Center for Innovation in Medical Education

LUMC

Je n’ai aucune affiliation

(financière ou autre) avec une

entreprise pharmaceutique, un

fabricant d’appareils médicaux

ou un cabinet de

communication.

I do not have an affiliation

(financial or otherwise) with

a pharmaceutical, medical

device or communications

organization.

Author: Tanja van Kempen MSc.

Date: oct/11/2012

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Tanja van Kempen MSc.

Educationalist

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overview

• Background

• What is a CAT?

• The problem

• Our solution

• Result

• Pros/cons

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Background

• CanMEDS in the Netherlands

2011

• role of scholar: the CAT was made

compulsory

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Do you know what a CAT is?

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Do you know what a CAT is?

• A Critically Appraised Topic (CAT) is a

practical tool for learning and applying

critical appraisal skills1,2

• EBM3

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CAT4

1. Patient encounter

2. Clinical question

3. Literature search

4. Critical appraisal

5. Summarising evidence

6. Commentary

7. Bottom line www.mediview.org

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CATs in education5

Undergraduate training programme

Clinicians

Postgraduate training programme

• concise and

connect theory to

practice

• self-teaching tool

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The question

• How can we implement this new

educational tool in the Leiden area?

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The problem

• The CAT was a completely new method

• We had a large number of residents who

had to be trained

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Our Solution

• Train the staff members in a Teach the

Teacher

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literature

• Role modeling is a powerful tool in EBM6

• Doctors often seem to have a lack of

knowledge about EBM terms, but the

majority wanted to know more about

EBM7

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The solution

• We developed a 2 day Teach the Teacher-

program for so-called CAT tutors

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Aims for the TtT

• Introduce the 7 step method

• Increase knowledge and skills

• Provide didactical background

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Teach the Teacher

Trainers

3 epidemiologists

1 pediatric cardiologist

1 clinical librarian

1 educationalist

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Teach the Teacher

Participants

Different specialists

from the whole

region

Minimal EBM skills

required

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Patient (practice) transition Medical science (literature)

1 clinical scenario

2 clinical question 3 literature search

4 critical appraisal

5 summarising

evidence 6 comments:

Thorough reflection on

the evidence

7 bottom line

Key words

TtT day 1

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Patient (practice) transition Medical science (literature)

1 clinical scenario

2 clinical question 3 literature search

4 critical appraisal

5 summarising

evidence 6 comments:

Thorough reflection on

the evidence

7 bottom line

Key words

TtT day 2

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Results

We evaluated the TtT in two ways

• immediate

• after 6 months

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Results after training

overall appreciation

N=37

M=4

Dev=0.5

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Results after training

relevance

N=38

M=4.2

Dev=0.5

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Results after training

combination of

literature and practice

N=38

M=3.9

Dev=0.7

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Results after training

active learning style

N=39

M=4

Dev=0.6

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Results after training

quality of the trainers

N=38

M=4.3

Dev=0.6

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Results after training

time investement

N=39

M=3.9

Dev=0.6

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Results after training

aims of the course are

reached

N=39

M=3.9

Dev=0.6

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Results after training

I am going to use some

aspects in practice

N=37

M=4.4

Dev=0.5

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Results after 6 months

I am using the course mainly for my own

work – I learned a lot! At this time I don’t

have any residents.

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Results after 6 months

The training was very good but its hard to

find time in our busy schedule to guide the

residents (25!) and let them present their

CATs.

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Results after 6 months

I am now more confident that I can help my

residents – those 7 steps where

completely new for me.

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Pros and Cons

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Pros of using a TtT for

implementing the CAT

• Important to include staffmembers in education

reform

• Updating skills and knowledge from staffmembers

• Education in EBM should be workplace related

• Many departments can be helped at the same

time

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Cons of using a TtT for

implementing the CAT

• It is impossible to foresee all the local problems

staffmembers encounter while introducing the

CAT in their department

• Sometimes it is difficult for staffmembers to

‘teach’ their colleagues

• The implementation depends on one

staffmember, if he/she doesn’t prioritise the

CAT, nobody will.

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Q & A

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literature

1 Dawes M. (2005) Critically appraised topics and evidence-based medicine journals. Singapore Med

J. 46:442-448;quiz, 449

2 Sauve S., Lee HN., Meade MD.m et al. (1995) The critically appraised topic: a practical approach to

learning critical appraisal. Ann Roy Soc Phys Surg Can 28:396-398

3 Kelly, A.M., Cronin, P. (2011) How to perform a critically appraised topic: Part 1, ask, search and

apply. AJR: 197 November 2011

4 Brouwer, de C. P.M. Training Critical Appraisal of a Topic. ISBN: 978-90-77201-31-2

5 Wiebe S. & Demaerschalk B. (2002) Evidence based care in the neuroschiences. Can J. Neurol.

Sci. 29: 115-119

6 Sacket et al. in Aiyer, M.K. & Dorsch, J.L. (2008) The transformation of an EBM curriculum: a 10-

year experience. Medical Teacher 30:377-383

7 Oliveri, R.S. Gluud, C. & Wille-Jorgensen, P.A. (2004) Hospital docters’self-rated skills in and use of

evidence-based medicine. J Evaluation in Clinical Practice 10, 2: 219-226

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• Teaching critical appraisal skills to health

professionals improves knowledge but

there is a lack of evidence that it changes

the process of care of patient outcomes.

There are large gaps in the evidence

(Cochrane review 2010)