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Pearls For Precepting - Handout

This document provides an overview of objectives and topics to be covered in a presentation titled "Pearls of Precepting 2012". The presentation aims to teach medical students and residents how to ask clinical questions, find good evidence to inform patient care decisions, and understand what types of evidence best address patient outcomes and priorities. Example background and foreground clinical questions are provided to illustrate the differences. The PICO framework is also introduced as a method for structuring clinical questions to facilitate evidence searches.

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60 views7 pages

Pearls For Precepting - Handout

This document provides an overview of objectives and topics to be covered in a presentation titled "Pearls of Precepting 2012". The presentation aims to teach medical students and residents how to ask clinical questions, find good evidence to inform patient care decisions, and understand what types of evidence best address patient outcomes and priorities. Example background and foreground clinical questions are provided to illustrate the differences. The PICO framework is also introduced as a method for structuring clinical questions to facilitate evidence searches.

Uploaded by

delap05
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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3/2/2012

PEARLS OF PRECEPTING 2012


Stephen D. Laird, D.O., MPH
Associate Dean for Academic Affairs
John H. George, Ph.D.
Associate Dean for Curriculum
Robert W. Baer, Ph.D.
Professor, Physiology

OBJECTIVES

• Asking Clinical Questions

• Web-based Precepting Tool

• What Is Good Evidence?


• How to find it

• Question Wrap Up

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3/2/2012

AUDIENCE

• Medical Students Years 1 &2 - Pre-Clinical

• Medical Students Years 3 & 4 - Clinical

• Residents

• None of the Above

TYPES OF QUESTIONS

• Background Question

• Foreground Question

CASE

• S: 10 year old male with a two day history of sore throat. He


denies a cough or runny nose. His mom states his oral
temperature was 101.5 degrees F. No other family members are
ill.

• O: Not toxic in appearance, Membranes are moist. Ears and TM


unremarkable, Throat is erythmatous with white patches
around the tonsillar areas. Positive lymph nodes anteriorly.
H: RRR without murmur, L: CTAB, Abd.: soft and nontender,
Skin: no rashes, MSK exam: acute tissue texture abnormalities
noted bilaterally T1-4 & C1-3

2
3/2/2012

BACKGROUND QUESTIONS

• Who?
• What?
• When?
• Why?
• Where?

CASE

• S: 10 year old male with a two day history of sore throat. He


denies a cough or runny nose. His mom states his oral
temperature was 101.5 degrees F. No other family members are
ill.

• O: Not toxic in appearance, Membranes are moist. Ears and TM


unremarkable, Throat is erythmatous with white patches
around the tonsillar areas. Positive lymph nodes anteriorly.
H: RRR without murmur, L: CTAB, Abd.: soft and nontender,
Skin: no rashes, MSK exam: acute tissue texture abnormalities
noted bilaterally T1-4 & C1-3

FOREGROUND QUESTIONS

• Ask for specific knowledge to inform clinical


decisions or actions

• Four essential components


• Patient and/or problem
• Intervention (or exposure)
• Comparison, if relevant
• Clinical outcomes, including time if relevant

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3/2/2012

PATIENT PERSPECTIVE

• What do patients care about?


• Patients don’t care about whether a medication will
lower their blood pressure but rather they want to know
“will it help to increase the length of my life or improve
the quality of my life?”
• Does the evidence affect:
• Mortality
• Morbidity
• Quality of Life

POEM

Patient-Oriented
Evidence
that Matters

Matters to the clinician, because if valid, it will require a


change in practice
Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A
Guidebook to the Medical Information Jungle. The Journal of Family Practice
1994;39(5):489-99.

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3/2/2012

RELEVANCE – TYPE OF EVIDENCE

• POEM: Patient-Oriented Evidence that Matters


• Mortality, Morbidity, Quality of Life
• Longer, better or both

• DOE: Disease-Oriented Evidence


• Pathophysiology, Pharmacology, Etiology

PICO

(P) Population/Patient
(How would I describe a group of patients similar to mine?)

(I) Intervention
(A cause, prognostic factor, or treatment)

(C) Comparison
(What is the main alternative to compare with the intervention?)

(O) Outcome
(What can I hope to accomplish? Patient perspective)

PICO QUESTION

• QUESTION: How should I treat non-stop hiccups in a


patient with HIV?
P In patients with HIV disease and non-stop hiccups
I What works
C As compared with nothing, which is what I’m doing now.
O To permanently stop these hiccups

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3/2/2012

PICO QUESTION

• I want articles on the use of hormone replacement


therapy after complete hysterectomy for treatment
of uterine cancer.

P In women who have had a hysterectomy for treatment of


uterine cancer
I Is hormone replacement therapy
C As safe and as effective as not using it
O To control symptoms of menopause

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