In order to prepare residents to handle the vast amount of scientific and clinical information available to them, there is a formal evidence-based medicine (EBM) curriculum that spans the three years of residency, as well as a multitude of opportunities to implement those EBM skills in real-time patient care activities. The curriculum draws on the expertise of faculty from many different divisions in the Department of Pediatrics, such as Emergency Medicine, General Pediatrics, Pulmonary Medicine and Infectious Diseases. Some have advanced training in epidemiology and dual-appointments in both Pediatrics and the University of Pennsylvania’s Center for Clinical Epidemiology and Biostatistics.
During the first year, interns build foundational skills in developing questions and literature seeking and retrieval skills, as well as how to catalogue the information they find using the expansive University of Pennsylvania’s online library resources. Basic EBM skills are applied to a practical clinical problem identified by the intern’s clinical experiences. Support for this curriculum is provided by the staff of the Biomedical Library of the University of Pennsylvania. In small groups, interns work through case scenarios and assess their skills as they are applied.
In the second year, this curriculum expands with topics focusing on elements of study design and understanding how to interpret the literature assembled to address a specific question. Residents gather and appraise literature to inform a Critically Appraised Topic. Residents present their findings and recommendations to their peers — findings grounded in the literature that they assembled and synthesized.
The growing evidence base for advocacy research has also been incorporated into our EBM curriculum in the form of our Advocacy Journal Club, where third year residents on their Advocacy Month present a topic with mentoring from a faculty member. Residents consider the research design, statistical methods and conclusions as they critique the manuscript chosen. Faculty experts assist in the preparation and give feedback on the presentation of this critical review. Group discussion that follows often centers on the groundwork for future advocacy research or policy work.
Real-time implementation of these skills occurs in a variety of settings. During morning report, specific questions that arise during clinical discussions may be addressed with targeted literature search strategies and discussion of the findings. Organized activities like these represent only the proverbial “tip of the iceberg” and the visible “formal curriculum.” The beauty of being at a place like CHOP, with its constant driving force of inquiry, lies in the “hidden curriculum” which includes the ongoing daily activities of residents caring for patients and participating on clinical teams. Here, questions are constantly being asked and answers sought. In these settings, the practice of EBM is modeled and taught by faculty and residents alike so the entire experience is a shared one.