• EBM Jeopardy Game

PowerPoint slides. Adapted from I.M.Quizitor97 which was produced by Oregon Health Sciences University Department of Internal Medicine. According to the I.M.Quizitor website, these files are made available courtesy of their developer, David Shenson, MD,OHSU Internal Medicine Chief Resident 1999-2000. They are free to download and use for educational (non-commercial) purposes only. Current version edited by Connie Schardt, Medical Center Library, Duke University September 2006.

• Question Building

PICO exercise cellphone-- Use a non-medical story; give them a worksheet and ask the group to write the questions they hear; then get the group to discuss the questions; can lead to a discussion of study design. (See attachment below comments)

• Engaging a large group in a demonstration that is not hands on

I have to do a morning report that includes about 20 students, interns and residents; I'm the only one with a computer; the challenge is to get everyone involved; I have used a variety of methods:
(1) type up real clinical questions using a variety of resources and searching tips that I want the learners to see; I fold up each question, put them in a basket and then pass that to the learners; they need to pick a question and tell us how to answer it; this usually leads to a discussion;
(2) write a "role" for each learner on an index card; number the roles in the proper sequence; then as I do the demo, I ask each number to provide the "role"; Examples of roles - read the case; problem, intervention; EBM Resources - one good study", etc.These are simple little techniques that makes everyone say something during the 7:30am report!! (Connie Schardt)

• Who wants to be a millionaire?

Nicola Pearce-Smith writes about using this game as an "ice-breaker" and a way to find out how much the class knows before you start you session.

• Summary of a posting from MedLib-L on examples of exercises to use with a class

From: Amy Blevins <blevinsamy@GMAIL.COM> Health Sciences Library -East Carolina University

I want to thank everyone who took the time to respond to my question. I really do appreciate your expertise. I ended up giving the students the following question at the start of class with a short worksheet. Please email me off-list if you want to see my worksheets. I basically asked them what the main concepts were that they needed to look for, where they would look for information, and how they would know whether or not it was good evidence. I then had them share their responses and quickly told them what I would have put on the worksheets. Since I had a small group, I walked around to see how they had run their searches. (I was hoping that they would have
used the information from the Duke tutorial on EBM (http://www.hsl.unc.edu/services/tutorials/EBM/welcome.htm) that I asked them
to go over the night before, but they didn't appear to have gone through it.

*Clinical scenario:* Our patient is a 45-year-old female who is experiencing moderate depression. After surfing the web, she believes St. John's Wort will cure her symptoms with less risk than conventional antidepressant medications. (Taken from Evidence Based Clinical Practice Tutorial http://www.urmc.rochester.edu/hslt/miner/resources/evidence_based/index.cfm).

I then showed them how to use Ovid's Medline and the Cochrane suite to answer the question. I gave them handouts on limits and publication types etc.

At the end of the class, I used the example from the Evidence Based Public Health tutorial that someone sent me. I had no idea that such a tutorial existed. It was a more difficult question, but I gave them the PICO worksheet from http://www.usc.edu/hsc/ebnet/ebframe/PICO.htm to assist them in structuring their search. Now, I know that I was told that Public Health
people don't normally use PICO, but I went ahead and used it to teach them and told them the P could stand for patient, problem or population.

*Clinical scenario:* Estelle Wilcox is Assistant Director of the Division of Personal Health at a mid-sized health department in a mid-sized town in the Midwest. She's concerned about overweight children in the local school district and wants to start a weight management program. Before Estelle inquires about funding for her idea, she'd like to find out some proven approaches and interventions to addressing the public health problem of obesity in children and the criteria for designing successful programs. (Taken from the Evidence Based Public Health Tutorial http://phpartners.org/tutorial/04-ebph/index.html).

When I looked over their searches at the end of class and we went over the worksheets together, they appeared to have gotten the idea of what evidence based searching is and how to do it. Again, if you would like to see any of my teaching materials, please let me know and I would be more than happy to share them.
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Other responses:

Forgive me if I'm pointing out something that is obvious to you already . . . But as I've discovered recently, Evidence-Based Public Health works a little differently than evidence-based practice in clinical medicine (or other clinical fields). I've been working on a project with Ross Brownson, who wrote the *Evidence-Based Public Health* textbook, and this has been very eye-opening for me. The terminology, process, evidence, and questions they ask are all a little different. PICO probably won't be as relevant to your students, although you can still talk about having a clearly defined question. If you have the Brownson text on the shelf in your library, I'd take a quick a look; and the PHPartners tutorial would also give you an overview: http://phpartners.org/tutorial/04-ebph/index.html. I think that either one will also give you a good feel for the types of questions public health students will find relevant for your class. You might even look at what issues are being studied or targeted by your local public health department.
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http://www.usc.edu/hsc/ebnet/ebframe/PICO.htm
I ended up using the worksheet from this website
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Did you come across Linda Schwartz's (Lehigh Valley Hospital and Health Network) summary email of humorous approaches to
teaching EBP? It was from April 13th. I am cutting and pasting it below for you. Maybe it would be of help.

I got my best idea from the first link -- and created a scenario for people to use to create a PICO-based answerable clinical question. My worksheet follows the summary. We haven't held the class yet so I don't know the response.

SUMMARY

I have a list of humorous items in various sections on my site: http://www.geocities.com/nqiya/libraryarticles.html
BTW, if you get a message that the site is currently unavailable, try visiting again later that day or the next. It's a free website, so they
have limits to the number of online visitors per hour.

http://www.geocities.com/nqiya/libraryarticles.html#MedicalHumor under EBM & Research Humor/Humour. For example, D'oh! An analysis of the medical care provided to the family of Homer J. Simpson http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1229893&blobtype=pdf

Having been stuck with a walker (and wheelchair) while recovering from broken ankle surgery, I really noticed Crankshaft cartoon where character worked on getting his mother to accept a walker - great pictures. Now that I have to wear support hose (to couteract swelling, I'm also getting the aging/old lady jokes. At least I can walk again, even if off balance (still in splint boot). Problem: Patient acceptance of assistive devices; attitude to aging..; they may come up with others (should be a nursing diagnosis that fits)See
http://www.kingfeatures.com/features/comics/crank/aboutMaina.php for info on access to back files of comic strips - wonder if they'd give you free permission to use? Let me know if you try - I'm thinking I may subscribe and see f they'll allow occasional use in presentations.

You might start by reading this tongue-in-cheek article from BMJ. A little British humor. Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled
trials. BMJ. 2003 Dec 20;327(7429):1459-61. Review. PMID: 14684649 [PubMed - indexed for MEDLINE]

I can't help in the design of a humorous worksheet on clinical questions and PICO, but I can give you a quasi-humorous line to use. Last year I gave a presentation on library resources dealing with evidence-based nursing, as part of a day-long nursing retreat. I took along a sign (matted and in a clear plastic envelope (I sell cards and prints at craft shows on occasion)) that I presented as "Evidence-Based Practice in a Nutshell." The sign says "Figure out what works. Do it that way."Nobody laughed, but I was the last speaker before lunch.
And whenever I go out to another department in the hospital for a presentation, I set up my computer and projector, and start out with
"Welcome to my fabulous traveling dog and pony show. <cough> Excuse me. I'm a little hoarse today."

When I was teaching the EBP Forum how to do research, I picked really goofy topics for them to do. That kept it light and it got them talking to each other and sharing their findings and suggestions. It worked pretty well. Some of the topics were: myths about hangnails;
open bruises; Do cats really smother babies?; How clean does a floor have to be? Most of the topics didn't have a lot of evidence, as you can imagine, but during the first session They learned a lot about narrowing and expanding topics. How to phrase the search etc. With it being a goofy topic the pressure was off of the less skilled computer users.

We did something here by having a "Deal or No Deal" program. They set up different cases with different questions on EBP. A power point went along with it giving the multiple choice answers. It was fun but also very educational

Several people suggested this one: BMJ. 1999 December 18; 319(7225): 1618. Copyright (c) 1999, British Medical Journal Seven alternatives to evidence based medicine David Isaacs, clinical professor and Dominic Fitzgerald, staff physician Free full text is
available in Pubmed Central: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28313

The first thing that came to my mind is the annual "humor" issues of journals such as the British Medical Journal. Each year, they publish an issue with humorous types of articles and if you used a case, perhaps, from one of those articles, you might find fodder for a humorous clinical question. I'm thinking this issue comes out in the fall but I'm not sure...

WORKSHEET
Evidence Based Practice
Outcomes Institute Project Worksheet

You are the nurse practitioner visiting Mr. Kung-Pao, a 52 year old Chinese-Canadian man on the day of his discharge from the heart unit for severe angina and CAD. His past medical and social history are benign except for a father deceased at age 75 from AMI and a past history of migraines. He has undergone cardiac catheterization and will be followed up by his cardiologist upon discharge for his coronary artery disease.

While reviewing discharge instructions with the patient, he asks you about his physicianƒs standard discharge recommendation that he drink a 4 oz. glass of red wine each day for its cardioprotective effects. He hates wine and wants to know why he canƒt have a beer instead. He says that beer is cheaper, doesnƒt leave stains and that „wine is for dorks.

Can beer have a cardioprotective effect? Youƒve read an article discussing resveratrol, an antioxidant found in the skins of red grapes. Does that mean that red wine is better? The article stated that long-term wine ingestion can be associated with negative factors such as snobbery and pretentiousness. Should the standard discharge instruction be changed to incorporate beer?

The cardiologist tells you to gather evidence and make a recommendation. Before looking for research evidence, create an answerable clinical question using the PICO method:

Identify the population (P)?
What intervention should be considered (I)?
What will the intervention be compared to - if anything (C)?
What outcome is important to the patient? (O)? To the caregiver? (O)
The clinical research question is: