Society for Academic Emergency Medicine
EVIDENCE-BASED EMERGENCY MEDICINE INTEREST GROUP
Minutes of Annual Meeting and Annual Report
Peter Wyer, Chair 6/7/00

ANNUAL REPORT OF INTEREST GROUP

During the first year of its existence, the Evidence-Based Medicine Interest Group served primarily as a forum for discussion and, in some cases, for facilitation of project development. Several projects were provisionally proposed at the inaugural meeting at the SAEM annual conference in Boston in May 1999, one of these being proposed during that meeting and the others offered for consideration by the chair. In the course of the year, some of these projects did move forward and were aided in this respect by members of the IG. The projects fell short of involving a broad sample of the IG membership and, although they were relevant to EBM, and potentially valuable to EM programs, they were not centrally related to the primary objectives of SAEM as an organization during this period.

At the interim meeting of the IG in October 1999, in the course of the ACEP Scientific Assembly, Gloria Kuhn proposed a survey of EM programs for the purpose of determining:

The level of incorporation of EBM into the curricula of such programs
The needs, limitations and obstacles confronting EM programs with respect to development of EBM as part of the curriculum
Areas in which the SAEM EBM IG might help address these needs and limitations

The survey was drafted by a project team under Gloria's direction, was approved by the CORD Board of Directors and was distributed to EM Program Directors via the CORD listserv on 5/3/00. It was also posted on the SAEM Website on the EBM IG page and was further promoted during the May annual meeting. As of the Annual Meeting, 31 responses had been received. The goal will be to obtain responses from the majority, if not all, EM programs, using multiple postings and direct calls on the part of the survey committee.

The EBM survey effort coincides with a parallel initiative on the part of the Agency for Healthcare Research and Quality (AHRQ), formally known as the AHCPR. The AHRQ seeks to identify GME programs within all specialties, as well as medical student initiatives, appropriate for a longitudinal study of programs that have pursued an EBM curriculum for at least 3 years and have addressed the following process components:

Defining the problem for a specific patient in the form of an answerable clinical question.
Conducting a search for the best evidence, including an efficient literature search.
Applying the rules of evidence to determine the validity and relevance of the evidence (critical appraisal).
Extracting the clinical message.
Applying the message to the patient.

The purpose of the AHQR investigation is to study approaches and innovations particularly promising as effective means of teaching EBM on an undergraduate and graduate level. Although the AHQR is not offering financial support to programs at this stage, their initiative is highly suggestive that external funding for EBM curriculum development and maintenance will become available in the coming period.

Pro-EBM initiatives on the federal level are joined by the identification by in-coming president Brian Zink of faculty development as one of three areas of emphasis on the part of SAEM during the coming year.

I therefore propose that the principal project of the EBM IG during the coming year be to systematically identify and describe the areas of faculty development required for EM programs to be equipped to incorporate EBM within their curricula and that this be a major component of the didactic proposals to be submitted by the IG to the Program Committee by August 28 for the SAEM 2001 annual meeting. I also propose that the following approaches be incorporated by the designated IG workgroup:

That several programs be chosen as the basis for identifying both the needs and also innovative approaches to addressing those needs. IG members from those programs should be included in the working group
That the project also attempt to identify and characterize the obstacles encountered by the model programs and the means used to overcome them
That the results of the PD survey be taken into consideration in this process

Other project activities related to the above objective include:

Rapid completion and tabulation of the PD survey
Initiation of work to develop a curriculum proposal for EBM within EM programs
Initiation of exploration of possible instructional modalities for EBM-related faculty development

It is important to observe that the preceding areas of activity are related to faculty development, they are not identical to it. Identifying faculty development needs were only one part of the PD survey. Curriculum development is directed to residents and medical students whose needs and interests may be different from those of faculty due to differences in learner level, clinical experience and motivation. Furthermore, a curriculum proposal will require an elaborated evaluation system with proposed measures of effectiveness in achieving curricular goals. Finally, the choice of appropriate instructional modalities for faculty development can only be made once the areas of need themselves are identified.

It would be appropriate for work committees to be formed in the areas of curriculum development, web-based and teleconferencing modalities for EBM teaching. In the latter areas, the initial investigation would best revolve around identifying the technological requirements, the resources required to harness those technologies and the available of the technologies on the part of EM programs.


OTHER PROJECTS

Several projects currently underway benefited from the collaborative resources of the IG during the year:

Survey of Cochrane reviews relevant to EM (Stephen Emond, Principal Investigator) This entails a systematic survey of the Cochrane Database of Systematic Reviews for the purpose of identifying reviews of immediate relevance to EM practice. The results will be submitted for publication and posted on-line.
On-line Systematic Reviews (Peter Dayan, Principal Investigator)
This is addressed to developing a format and protocol appropriate to on-line reviews of focused practice topics in EM.

Full reports of these projects will be made available on the EBEM listserv as they emerge.