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Traditional Expert-Based Information Delivery Systems

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This is a commonly-bandied about statistic, ... not necessarily therapy Not trained in clinical epidemiology ... Introduction Author: – PowerPoint PPT presentation

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Title: Traditional Expert-Based Information Delivery Systems


1
Traditional Expert-Based Information Delivery
Systems
  • Using an Expert, Being an Expert

2
Roles of Experts
  • Consultation
  • CME
  • Review articles
  • Practice guidelines
  • Decision analysis

3
Using an Expert/Being an Expert
  • Definition of an expert
  • Subspecialist or primary care clinician with
    special interest
  • Anyone/anything you go to for an answer to a
    question

4
Using an Expert/Being an Expert
  • Never ask the barber whether you need a haircut
  • So many specialists fall into the habit of
    looking where the light is -- that is, offering
    solutions only in territory familiar to them. . .
    Wonderful examples exist of otherwise excellent
    researchers who are unable and unwilling to
    recognize evidence contrary to their beliefs.

5
Usefulness Score
  • Work Low
  • Significant potential for usefulness
  • Relevance Varies
  • Validity Expert dependent
  • If either relevance or validity is zero,
    usefulness is zero

6
Types of Experts
  • Content Expert
  • Clinical Scientist
  • YODA

7
Content Expert
  • Experienced, particularly diagnosis and
    procedures, not necessarily therapy
  • Not trained in clinical epidemiology (validity)
  • Traditional education favors DOEs (relevance)
  • May not be current, may rely on anecdotes
  • Risky extrapolation Information is only as
    current as the last consultation

8
Clinical Disagreement Between/Within Experts
  • Same film disagree 29 of time
  • Previous read disagree with self 20 of time
  • Studied with venograms, fundi, MRI, angiography,
    mammograms, pathology (melanoma diagnosis)
  • March 97 Bandolier on the Web Histology as Art
    Appreciation

9
Never ask a barber . . .
  • Chalmers Recommendation highly correlated with
    training and source of income
  • Management of acute GI bleed
  • Surgeons surgery- 50 conservative- 15
  • Internists surgery- 15 conservative- 50

10
Clinical Scientist
  • Good at evaluating evidence up-to-date, dont
    have to be content experts
  • Separation of therapeutics
  • Medical Librarian, PharmD

11
(No Transcript)
12
YODA Your Own Data Analyzer
  • Content expert and clinical scientist
  • Consider POEMs first, even if this information
    conflicts with DOEs or clinical experience
  • When POEMs not available, use best DOEs with an
    open mind
  • Demonstrate appropriate validity assessments
  • Not to be confused with YUCKs

13
YUCK
  • YOUR
  • UNSUBSTANTIATED
  • CLINICAL
  • KNOW IT ALL

14
Experts gone wrong YUCKs
15
YUCK
  • Your Unsubstantiated Clinical Know-it-all
  • Maladaptive
  • Rigid, Dogmatic
  • All personality types, but people who see things
    in Red and Green can fall into the YUCK trap

16
The Golden Question Thats interesting . . . Is
there any evidence that . . . ?
17
If its not a valid POEM, its just not
necessarily so
18
Making the Most of a CME Presentation
19
Dilberts Take on CME
20
(No Transcript)
21
Continuing Medical Education
  • People remember 90 of what they do, 75 of what
    they say, but only 10 of what they hear
  • How to make the 10 count

22
Do We Get Something From CME?
23
Is post-test performance improved? (DOE)
  • YES
  • Beware Chinese-Dinner Memory Dysfunction

24
Are patient outcomes improved? (POEM)
  • No . . .Multiple RCTs have failed to find a
    benefit from traditional lecture format (passive)
  • Maybe . . . with active (hands-on) workshops
    combined with close follow-up

25
Usefulness
  • Validity Depends on the speaker
  • Relevance Depends on POEMDOE ratio
  • Work Higher than it seems
  • NBA analogy (only last two minutes count)
  • Tracking down validity of new POEMs

26
Role of the Speaker
  • Present a good mix of POEMs highlighted by
    clinically relevant DOEs
  • Augment POEMs with clinical experience
  • Identify Level of Evidence (LOE)for listener

27
Role of the Listener
  • Identify, before the talk begins
  • What you want to learn
  • What are the POEMs you need to know?
  • Actively evaluate information (CME worksheet)
  • When a change-inducing POEM is presented,
    validate
  • By questioning the speaker
  • By cross-checking with other sources

28
Identifying Common POEMS
  • Will this information have a direct bearing on
    the health of my patients (is it something they
    care about)?
  • Is the problem common to my practice?
  • Is the intervention feasible?
  • If true, will it require me to change my current
    practice?

29
Newer Models for CME
  • Practice-based small group CME
  • Educational prescriptions
  • Point of care Sources
  • Team-based learning
  • Audience response systems
  • CME worksheet
  • Social media
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