TEACHING EVIDENCE BASED PRACTICE

TEACHING EVIDENCE BASED PRACTICE Random thoughts in a nutshell Robert J. Weyant, DMD, DrPH Chair, Department of Dental Public Health University of Pi...
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TEACHING EVIDENCE BASED PRACTICE Random thoughts in a nutshell

Robert J. Weyant, DMD, DrPH Chair, Department of Dental Public Health University of Pittsburgh School of Dental Medicine

Who we teach •

Dental students



Dental faculty



Practicing dentists

What do we teach •

Just in time (not just in case) individual patient treatment decisions.



Some use of guidelines.

Challenges: Dental Students Challenges •

Lack of clinical knowledge



Lack of vocabulary



Lack of understanding of practice needs



Busy with “real” dental courses

Opportunities

Challenges: Faculty Members Challenges

Opportunities



Already know everything



Captive audience



Busy





Don’t “get it”

Access to medical library (online resources)



Don’t want to look foolish



Don’t want to look foolish

Challenges: Practicing Dentists Challenges •

Busy



Lack access to online resources



Economic concerns

Opportunities •

Eager (if paying for CE)

Didactic Teaching First Year EBD Course Second Year Research Course

Start with a strong rationale Dental Students • •

Just want the “answers”

Practitioners •



Lack Perspective •

Don’t understand that science/practice changes

Strong Rationale

Need to see examples.



They already practice EBD…

Manage fear of change

Demanding evidence… she averted a US tragedy.

Strong Rationale

Francis Kelsey, MD Carl Henegan, Oxford

Julies Back to Sleep slide Bad things happens when we don’t look at evidence

Strong Rationale

Many “Leaks” from research to practice

Aware Accept Target Doable Recall Agree Done

Valid Research If 80% achieved at each stage then 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21 Strong Rationale Paul Glasziou

Teaching Philosophy: Dental Students •

Start early in curriculum



Easy and Rewarding



Reinforce for all four years



Skill development

EBD Taught Early and Often D1 Didactic

EBD/Stats

Clinical

Case presentation Adolescent clinic

Start Early

D2

D3

D4

First-year course •

Classic EBD material



Just enough stats



Asking (PICO)



Descriptive (review)



Accessing



P-value



Assessing



Confidence interval



Applying



Measure of effect



Diagnostic Test

Weyant’s Rules for Easy and Rewarding EBF Secondary Sources ONLY (at first) No wild goose chases Keep it simple (at first)

Search Strategy Question (PICO) Check MeSH

Check for 2nd Sources Here: • TRIP • Cochrane • ADA EBD • NGC

Search 2nd Sources

No PICO – search strategies for PubMed

PubMed (Clinical Queries)

Yes STOP

Weyant’s Rules for Teaching Statistics Formulas = Failure

Less is More Teach for Consumption Make it Sticky

Important concepts:

Education is the path from cocky ignorance to miserable uncertainty. Mark Twain

Uncertainty

Important concepts:

Lack of Evidence

There is insufficient evidence to determine the effects of routine scale and polish treatments. High quality trials conducted in general dental practice settings with sufficiently long follow-up periods (five years or more) are required to address the objectives of this review.

In three studies, the panel found no benefit of using prophylaxis pastes containing fluoride on the primary or permanent teeth of children.

Worthington et al., Routine scale and polish for periodontal health in adults. Cochrane Review, 2013

Weyant et al., Topical fluoride recommendations, JADA 2013

Absence of Evidence

Evidence of Absence

Important concepts:  Study size and p-value?  Surrogate endpoints  NNT

Clinical Significance

EBD Taught Early and Often D1 Didactic

EBD/Stats

Clinical

Case presentation Adolescent clinic

Reinforce in clinic 4 yrs

D2

D3

D4

EBD Taught Early and Often D1 Didactic

EBD/Stats

Clinical

Case presentation Adolescent clinic

Reinforce in clinic 4 yrs

D2 Research Skills Course

D3

D4

[Case Presentation]

Senior Case Presentation

EBD Clinical Worksheets

EBD Clinical Worksheets

Experiential Learning EBP is a SKILL and requires PRACTICE

POGIL Sessions

Simulated Cases

Clinical EBD Worksheets

Small Group Teaching POGIL Case-Based Learning (HPDP)

Processed Oriented Guided Inquiry Learning (POGIL) https://pogil.org/about  Self managed teams  Guided exploration to construct learning  Focuses on higher level thinking skills

POGIL: The Model Model 1

Model 3

The POGIL Process Learning Cycle

Process Skills

1. A Question 2. Observation or data collection to DEVELOP concept. 3. Guide to conclusion 4. Application

• • • • • •

Teamwork Oral + written communication Management Problem solving Critical Thinking Assessment

Small Group Case Based Learning • • • •

SES: High Knowledge of oral disease: good Medical: Type 1 Diabetes Dental: – –

Regular utilization of dental services. No sealants

• • • • •

Minor Plaque No calculus Slight gingivitis No Caries or restorations Occlusion – •

under treatment for overjet and crossbite

ADA Sealant Recommendations

ADA Guidelines on topical fluoride

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Clinical Teaching EBD Worksheet Senior Case

What’s different about teaching graduates (faculty and practicing dentists)?

   

Adult Learning Model Shorter course Different rationale More cognitive bias and cognitive dissonance

Where do we go from here…

Full implementation of Evidence-based Program • • •

Risk Assessment Diagnostic Codes Summary Reports

axiUm Faculty training (coaching)

Policy changes

Robert J. Weyant, DMD, DrPH Chair, Department of Dental Public Health University of Pittsburgh School of Dental Medicine

[email protected]

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