Evidence-based medicine training: Reaching the front line clinician in an integrated medical care system

Tags: Oral
Ching K1, Regidor D2, Okawa G1
1Hawaii Permanente Medical Group, US, 2Kaiser Permanente Care Management Institute, US

Background: A shared language surrounding assessment of medical literature and translation into evidence-based practice (EBP) is central to providing high-quality, coordinated, outcomes-based medical care. There are few structured evidence-based medicine (EBM) training programs targeting front line clinicians in a community setting. A large regional medical group (more than 400 physicians) embraced a program promoting a system-wide culture of EBM. EBM foundations training was developed to provide reinforcement through hands-on experience and system-wide dissemination through a regional grand rounds program.

Objective: To create a culture of evidence-based practice in a single healthcare system through integration of an evidence-based foundations training course into a regional grand rounds program.

Methods: A four-hour interactive training session targets the principles of EBM and EBP during grand rounds content development. Further EBM support is provided at follow-up sessions. In the grand rounds program, presenters must provide a rationale for key clinical recommendations by synthesizing the best available evidence using standard formats for evidence and recommendation grading. Physician clinics close for grand rounds, consistent language for medical evidence is used system-wide, and intranet posting reaches about 2000 healthcare professionals.

Results: Since 2009, there have been 51 course participants, including physicians and allied health professionals. Grand rounds attendance averages 57% of the medical group. To date, over 68 graded recommendations were made across 21 clinical topics. Course evaluations show high satisfaction and achieved course objectives. Grand rounds participant evaluations demonstrate clarity of the evidence base for clinical recommendations (96% positive response). Improved outcome measures from specific recommendations can be demonstrated as part of a broader, multi-faceted process, of which EBP is an important component.

Conclusion: A structured, interactive EBP training program integrated into a regional grand rounds program can successfully reach front line clinicians, and advance evidence-based culture throughout a healthcare system.