Health Management and Clinical Decision Making

The Workshop Model

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How to teach evidence-based clinical practice to clinicians.
Murad MH, Montori VM, Kunz R, Letelier LM, Keitz SA, Dans AL, Silva SA, Guyatt GH. 2009 Dec;15(6):1205-7
This paper summarizes 20-year experience of conducting a workshop designed for educators who wish to improve their teaching skills of evidence based medicine (EBM). The goal is to provide tips for educators interested in replicating this educational model.


The History of EBM

Where is the wisdom? II - Evidence Based Medicine and the epistemological crisis in clinical medicine.
Silva SA, Wyer P. Journal of Evaluation in Clinical Practice. 2009; 15(6):899-906
Challenges to EBM on epistemological and philosophical grounds have constituted a prominent aspect of criticisms of EBM
since the 1992 proclamation. However, responses to criticisms from the EBM camp have been confined to methodological issues pertaining to clinical research designs and to general goals and objectives. This paper addresses recent
contributions in the debate about the epistemological and philosophical
challenges of EBM.

Where is the wisdom? I - a conceptual history of evidence-based clinical practice.
Wyer P, Silva SA. Journal of Evaluation in Clinical Practice. 2009; 15(6):891-9
This paper undertakes a critical review of the history of the EBM movement, beginning with its origins in the 1970s and continuing through this century. It is drawn upon the results of an independent project that rationalized the EBM domain from the perspective of educational evaluation and assessment, considering the content of EBM in relationship to the propositions and promises embodied in advocacy publications.


The SIMPLE model

The Roadmap: a blueprint for evidence literacy within a Scientifically Informed Medical Practice and Learning Model
Suzana Alves Silva and Peter C Wyer. 2013; 1(1):53-68
This paper addresses a model of clinical practice that encompasses clinical relationships and choices as well as the use of clinical research. It integrates concepts borrowed from narrative medicine with the results of a competency-based assessment project. The SIMPLE model defines 3 sub-categories of Problem (utility, performance and likelihood) leading to shared Actions, Choices and Targets (PACT) as a bridge between relational and information literacy fields. The enabling skill ‘ask’ and the “Patients, Interventions, Comparisons, Outcomes” (PICO) format, are applied uniformly across these categories. 

The marriage of evidence and narrative: scientific nurturance within clinical practice.
Silva SA, Charon R, Wyer P. Journal of Evaluation in Clinical Practice. 2011;17(4):585-93
This paper describes a tool of representation, whose components are Problem delineation, Actions, Choices and Targets that enables the clinical problem to be delineated with reference to utility, performance and frequency under the four domains of clinical action: 'therapy', 'diagnosis', 'prognosis' and 'harm'.



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