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INTRODUCTION TO EVIDENCE-BASED MEDICINE

Third Year Medicine Student:

As you know from the syllabus, you will spend Monday afternoon in the Stritch School of Medicine for sessions on clinical decision making (otherwise known as evidence based medicine).

Attached are packets of material for the first two general sessions on diagnosis and therapy. Note: YOU MUST READ THIS MATERIAL AHEAD OF TIME. Likewise, you will not be able to take part in an intelligent discussion if you have not reviewed the material from last year. To that end, I have provided a list of those things you should have learned in school. DO NOT COME NEAR THESE SMALL GROUP SESSIONS UNLESS YOU KNOW ALL THE CONCEPTS ON THIS LIST. By 'know' I do mean 'able to discuss', not 'I think I have heard of that somewhere'. Thanks. It should be fun.

In order to participate in the evidence-based medicine discussions, you must have the ability to use the following concepts:

 

List A

Sensitivity
Specificity
Positive Predictive Value
Negative Predictive Value
Pre-test Odds
Odds Ratio
Relative Risk
Absolute Risk
Confidence Interval
Post-test Odds
Bayes' Theoreum
Number needed to treat
SnOut
SpIn
Conditional Probability

 

By ‘use the following concepts' I do not mean get the right answer on a multiple choice test. I do mean, understand the concept, be able to apply it to a real clinical situation, and be prepared to use it in a discussion. We will not stop to review these concepts again - they are all explained in the required text and your class notes from last year. If you have trouble with them, I will be happy to resolve any lingering ambiguities.

It is also assumed, based on previous course work, that you will have an understanding of the following concepts:

 

List B

Odds
Probability
"P" value
Power
Sample Size
Stratified Randomization 
Randomized Controlled Trial
Confounding
Intention to Treat Rule
Incidence
Prevalence
Case-control Study
Cohort (Prospective) Study
ROC Curve

 

Without an understanding of these basic concepts, our discussions will be of little value - to you or me.

R. Cooper, M.D., Ext 79010; Email rcooper@lumc.edu


This material represents a continuation of the teaching experience in evidence-based medicine and clinical decision making that was introduced in the first two years. We will extend the material and integrate it further into the clinical setting.

After the introductory session, the presentations will focus on cardiovascular disease, breast cancer, and prostate cancer. Reading and exercises will be distributed ahead of time. The first 1.5 hours will be spent reviewing the basic concepts of clinical decision making on the disease topic with the instructor. After a break, clinical examples on the same topic will be discussed.

The required text is Sackett et al. Clinical Epidemiology: A Basic Science for Clinical Medicine, Little Brown and Company, 1991, which will be available in the bookstore. A copy will also be on reserve in the library.

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achandr@lumc.edu
Last Updated: February 9, 1999
Created: February 9, 1999