Journal Article Annotations
2017, 4th Quarter
Annotations by Diana Robinson, MD, and Jordan Rosen, MD
Type of study: Cross-sectional survey study of a pilot curriculum followed by a prospective cohort study
The finding: The authors conducted a pre- and post- curriculum survey of a pilot evidence based medicine curriculum as well as pre- and post-curriculum chart reviews to assess for implementation. 15 residents and 4 fellows on cardiology consults participated as well as 72 of 90 residents on general medicine rotations. 80% of residents found the curriculum was educationally valuable. 73% of residents found that the EBM talking points were valuable to the primary team. 48% of residents thought that the EBM template and EBM thought process influenced clinical decision-making. 100% of primary team residents who received an EBM teaching pearl in the consult notes thought it was educationally valuable. It changed the clinical management in 48% because of the EBM teaching points. The most commonly cited barriers to implementation were increased time of note writing, residents not including an EBM pearl when it conflicted with attending recommendations, or not including an EBM pearl when there was conflict between EBM and expert consensus.
Strength and weaknesses: The strengths of this study include the novelty of a pilot evidence-based medicine curriculum and EBM coaching on a cardiology consultation elective rotation. The program was so well received that it was extended to all medicine subspecialties at the academic medical center primary site. The curriculum and resulting changes were perceived by residents on the consult team and primary teams to affect clinical decisions, to increase communication of evidence, and to be educationally valuable.
Weaknesses of the study include a single study institution, limitation to one medical subspecialty consultation service (cardiology, later was extended to all medical subspecialties but additional data was not reported), small sample size, and the instrument lacks validity evidence.
Relevance: It is a core competency to teach psychiatric trainees on CL to improve the qualty of their recommendations as well as to improve their liaison abilities to communicate between the consulting team and primary team. Teaching residents to incorporate and communicate evidence based medicine into their consultation notes and discussions with the primary team can increase the number of consults that deliver high-value care. Additionally, these skills will be all the more important in the context of value-based care structures.
Type of study: A cross-sectional survey study of a pilot curriculum
The finding: The authors conducted a pre- and post-lecture survey of 13 Internal Medicine residents using an 11-question instrument with ten Likert scale questions and one free response question. The survey focused on subjective knowledge and confidence in treating common psychiatric problems in relation to a lecture series designed and delivered by Psychiatry residents under the supervision of faculty. In general, the IM residents reported improved knowledge and subjective skill with managing all psychiatric problems covered in the lecture series, with statistically significant findings in improvement of knowledge and management of depression and demoralization as well as capacity assessments. Additionally, Psychiatry residents reported benefitting from engagement in a project which contributed to the completion of part of their ACGME core competencies.
Strength and weaknesses: The pilot project demonstrated that an interdisciplinary, resident-led lecture series can be effective at improving perceived ability of internal medicine residents to manage certain common psychiatric presentations. The lectures were well-received from both specialties with qualitative improvement in the relationship between services. Weaknesses of this study include a single study institution, small sample size, and qualitative data which all serve to limit overall generalizability. In addition, due to rotation and call scheduling, the audience and lecturers were variable which could have impacted the results.
Relevance: With an increasing need for psychiatric care and a short supply of psychiatrists, disseminating psychiatric knowledge and skill to other specialties allows for more patients to receive appropriate care. This study showed that interdisciplinary, resident-led lectures can increase knowledge and management of common psychiatric issues while providing more experience to psychiatric residents in providing collaborative care.