Key competencies in evidence-based health care

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Some key competencies in evidence-based health care
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Contents

Last Update

This entry is out of date, and will not be updated, June 2017

Introduction

See also Evidence-based health care | Health literacy | Information literacy | Medical education portal | Shared decision-making in medicine

What are the key competencies in evidence-based health care? EBM experts have recommended that clinicians demonstrate these broad competencies:

  • formulating clinical questions such that that they are answerable (see five steps of EBM}
  • ascertaining which resources are best suited for answering clinical questions and efficiently finding resources
  • appraising the retrieved evidence, understanding its limitations and deciding if and how to use it in patient care (see Point of care tools}

Towards EBHC competencies

The Centre for Evidence-based Health Care in South Africa has come up with specifics around integrating EBHC competencies into coursework and programs. CEBHC faculty are in the process of reviewing the attributes of newly-qualified health professionals and have adopted the CanMEDS framework to do so. CanMEDS was developed in 1997 and has been used in medical education around the world. CanMEDS serves as a useful guide in listing the essential knowledge and skills for physicians in order to optimize patient outcome; it also defines the attributes of graduates according to seven interdependent roles:

  1. Medical expert
  2. Scholar - Professional
  3. Communicator
  4. Collaborator
  5. Manager
  6. Health advocate

These are all individually defined and described according to key competencies and enabling competencies. Faculty has assembled working teams of lecturers, module chairs and relevant academic staff for each role. The team examining the “scholar” role in evidence-based health care (EBHC) competencies is a big part of the overall competencies. Last year, key and enabling competencies were developed according to the five steps of EBHC (asking, accessing, appraising, applying, auditing), and integrated these as part of the formal competencies under the “scholar” role.

Key competencies (undergraduate)

1. ASK

a. Identify knowledge gaps
b. Formulate focused answerable questions using the PICO format when faced with an uncertain situation
c. Identify the various types of questions

2. ACCESS

a. Identify and understand the best sources of evidence for each type of question
b. Design a search strategy relevant to the question
c. Identify appropriate databases
d. Search effectively and efficiently for evidence-based resources;

3. APPRAISE

a. Appraise different types of research for their validity, reliability, and applicability
  • systematic reviews, randomized controlled trials, cohort studies, case-control studies, cross sectional studies, diagnostic studies, interpret research findings
c. Translate outcomes into meaningful summary statistics

4. APPLY

b. Know the approach to assess applicability and generalizability of research findings in clinical practice

Enabling competencies

  • biostatistics – hypothesis testing, estimation and confidence intervals, sample size calculation
  • epidemiology - study design, measures of occurrence, measures of effect and association, screening (sensitivity, specificity, likelihood ratios, predictive values), bias and error, confounding, causation
  • searching electronic databases – principles
  • identify appropriate search terms
  • use Medical Subject Headings (MeSH) in search
  • explode MeSH terms to expand retrieval of studies
  • use appropriate limits (e.g. age, gender, publication type)
  • use Boolean operators correctly
  • use search concepts in final search strategy

Philosophy of critical enquiry

The competencies for each role should be a part of the medical curriculum. For postgraduate training, a formal evaluation of online EBM moduled is needed. Its aim is to inform development of generic online modules which can be offered to all medical specialists in training. The postgraduate competencies are similar to the undergraduate competencies, but comprise the whole process of EBHC.

Key competencies (postgraduate)

1. ASK

a. Identify knowledge gaps
b. Formulate focused answerable questions using PICO
c. Identify the various types of questions

2. ACCESS

a. Identify and understand the best sources of evidence for each type of question
b. Design a search strategy relevant to the question
c. Identify appropriate databases
d. Search effectively and efficiently for evidence-based resources

3. APPRAISE

a. Appraise different types of research for their validity, reliability, and applicability
  • systematic reviews, randomized controlled trials, cohort studies, case-control studies, cross sectional studies, diagnostic studies, interpret research findings
c. Translate outcomes into meaningful summary statistics

4. APPLY

a. Assess applicability & generalizability of research findings in clinical practice
b. Integrate research into decision making for individual patients

5. ASSESS

a. Monitor and evaluate the application in practice

Enabling competencies

  • biostatistics – hypothesis testing, estimation and confidence intervals, sample size calculation
  • epidemiology - study design, measures of occurrence, measures of effect and association, screening (sensitivity, specificity, likelihood ratios, predictive values), bias and error, confounding, causation
  • searching electronic databases – principles
  • identify appropriate search terms
  • use Medical Subject Headings (MeSH) terms in search
  • explode MeSH terms to expand retrieval of studies
  • use appropriate limits (e.g. age, gender, publication type)
  • use Boolean operators correctly
  • combine search concepts in final search strategy
  • monitoring and evaluation – principles
  • philosophy of critical enquiry & critical thinking
  • reflection

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