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Acad Psychiatry. 2008 Nov-Dec;32(6):475-83. doi: 10.1176/appi.ap.32.6.475.

Guided mentorship in evidence-based medicine for psychiatry: a pilot cohort study supporting a promising method of real-time clinical instruction.

Author information

  • 1Stanford University, Psychiatry and Behavioral Sciences, Stanford, CA 94305-5722, USA. amascola@stanford.edu

Abstract

OBJECTIVE:

Evidence-based medicine has been promoted to enhance clinical decision making and outcomes in psychiatry. Residency training programs do not routinely provide instruction in evidence-based medicine. Where instruction exists, it tends to occur in classroom settings divorced from the clinical decision-making process and is focused narrowly on appraisal of evidence quality. The goal of this pilot study was to develop and evaluate the promise of a method of "hands-on" instruction in evidence-based medicine done in real clinical time.

METHODS:

A modularized curriculum to promote decisionmaking strategies using evidence-based medicine during the course of actual patient care was delivered by an attending physician mentoring a small team on the inpatient and consultation-liaison psychiatry services at Stanford. A staggered cohort of 24 consecutive trainees was followed between August and January 2007. Measures of trainees' skills in evidence-based medicine were assessed before and after mentoring. A blinded grader scored each inventory according to an explicit, predefined rubric. Demonstrated proficiency in delivery in each of the core skills of evidence-based medicine was assessed as a secondary outcome measure via the attending physician's unblinded subjective evaluation of trainee performance. Subjective descriptions of the experience were obtained via review of trainees' evaluations.

RESULTS:

Postmeasures of knowledge and skills in evidence-based medicine increased significantly relative to baseline. The Cohen's d effect size was large and clinically meaningful. The majority of trainees were able to demonstrate adequate proficiency of skills by attending subjective evaluation. Trainees' subjective experiences overall were positive.

CONCLUSION:

Guided mentoring in evidence-based medicine appears promising for further study.

PMID:
19190292
[PubMed - indexed for MEDLINE]
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