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Portland Campus · School of Medicine

Evidence-Based Medicine
BMI-536

  • Summer 2019
  • 3 Credits
  • 06/24/2019 to 09/13/2019
  • Modified 07/29/2019

Description

This hybrid course provides a rigorous introduction to the principles of evidence-based medicine (EBM). It begins with an overview of how to frame an answerable clinical question and then find the best evidence to answer it. The major categories of questions that arise in clinical practice - treatment, diagnosis, harm (etiology), and prognosis - are each covered, with instruction on what is the best type of evidence to answer questions, how to find that evidence, and how to apply it to a given patient. This is followed by units on summarizing evidence (e.g., through systematic reviews and meta-analysis), putting evidence into practice (e.g., implementing clinical practice guidelines), and the limitations of the EBM approach. Some pre-campus coursework is required. See syllabus for details.

Prerequisite: BMI 510/610

Offering: On Campus: Hybrid Course, September

Requisites

This course is open to all OHSU biomedical informatics students and others by permission of the course director.

Contact Information

William Hersh, M.D.
Professor and Chair
Department of Medical Informatics & Clinical Epidemiology
Oregon Health & Science University
BICC
3181 SW Sam Jackson Park Rd.
Portland, OR 97201-3098
Voice: 503-494-4563
Fax: 503-494-4551
Email: [email protected]
Web: http://www.billhersh.info

Meeting Times

The course is taught in two parts. The first part consists of a pre-campus portion that consists of online lectures and assignments consisting of critical appraisals of different question types. The content will be posted approximately six weeks before the virtual on-campus session, starting around August 1, 2019. This content consists of 8 units, listed in the table below, that will all be posted when the course opens or shortly thereafter. (Unit 9 will be presented live during the virtual on-campus portion.) The activities for each unit of the course consist of:

  • Reading assignment from textbook
  • Short on-line lecture
  • Critical appraisal of a study (one each for units 2-8, for a total of 7) using a template, submitted via Sakai

 

The second part of the course for this year will be a virtual session from September 10-11, 2019 from 8 am-noon, PST, each day. In mid-August, students will sign up for presentations in the virtual session, all of which they are expected to attend. Based on the current projected enrollment in the class, each of you will be asked to present one of your critical appraisals each day. You should plan to present for 15-20 minutes and discuss your study and its critical appraisal. I will let you propose the topics you want to present but may need to negotiate with you to make sure that all of the course topic areas are covered.

 

Students should have their articles for appraisal selected by the due date for signing up for presentations. You should aim to complete first versions of all of your appraisal templates before August 30, 2019. (Please note: Dr. Hersh will be on vacation from August 29-September 8. He will be occasionally checking email and Sakai during that time but may be delayed in doing so.) Students must complete all 7 critical appraisals correctly to meet the requirements for the course. The final appraisals will be due by September 13, 2019, after which grades will be reported back to students.

 

 

Materials

The course textbook is: Guyatt, G, Rennie, D, et al., Eds. (2015). Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice, Third Edition. New York, NY, McGraw-Hill.

 

Students should also set up a JAMA Evidence account through the OHSU Library, including from off campus. This site provides access to the critical appraisal templates, the larger encyclopedic version of the textbook (which you are welcome to read instead of the smaller assigned book for the course, which is not on the Web site), and many other EBM resources.

Course Goals

Course Competencies, Outcomes, and Objectives

Assessment

Assignments

The course assignments consist of critical appraisal of seven different study types (one each for units 2-8, for a total of 7) using the template provided with the course materials. You must choose an article published in the literature of the appropriate study type that was not mentioned in the lecture or textbook. You must choose studies on clinical topics and not informatics topics (e.g., studies of tests and treatments and not studies of CPOE or clinical decision support). The 7 appraisals should be done using the templates from the JAMA Evidence Web site (also posted to Sakai) with the exception of the clinical prediction rule worksheet that has been adapted from an Internet site.

 

 

When you turn in an assignment, please also attach the PDF of the article to your submission. That way, those of us grading the appraisal can look at the actual paper without having to go retrieve it on line. Your file and the PDF of the article should be uploaded to the Sakai Submissions area. Please name the file with your last name, a dash, the unit number, another dash, and then whatever else you want. So for example, if I was turning in an assignment for Unit 4, I would name my appraisal Hersh-4-Diagnosis.docx and the article I was appraising as Hersh-4-ArticleAuthor.pdf.

 

You should turn in all 7 of your assignments by September 9. The instructor will provide feedback on all submitted assignments as they are submitted, and assignments that are incorrect (e.g., wrong study type selected, wrong information entered on to template, etc.) will need to go through one or more cycles of “revise and resubmit.” Ultimately, all appraisals must be done correctly. All appraisals must be finalized by September 8 to pass the course. (There is neither a final examination nor any other course projects.)

 

For intervention and harm studies, please choose a study that has a “positive” outcome so that you can calculate the classical EBM statistics.

 

Grading

Student grades will consist of critical appraisals (80%) and on-campus class presentation and participation (20%). Appraisals must be done until they are considered satisfactory. Completing all of them satisfactorily, along with participating in class, will result in an A grade. Lesser completion of assignments or class participation will result in a lower grade.

 

Course & Instructor Evaluations

Schedule

The table below lists the topics of each unit, the appraisal template required (for units 2-8, with units 4 and 6 only requiring one to be completed from the list presented), and the reading from the course textbook.

Unit

Topic

Appraisal

Reading

1

Introduction – questions and evidence

N/A

1-5

2

Intervention – single studies

Therapy.docx

6, 8-9

3

Harm

Harm.docx

10

4

Diagnosis – diagnostic tests

Diagnostic.docx

11-12

5

Diagnosis – clinical prediction guides, screening

Choose one from:

Prediction.docx

Screening.docx

11

6

Prognosis

Prognosis.docx

13

7

Summarizing evidence – systematic reviews and meta-analysis

Summarizing.docx

14-15

8

Patient management recommendations – clinical decision analyses, clinical practice guidelines, and economic analyses

Choose one from:

Guidelines.docx

CDA.docx

Economic.docx

17

9

Evaluation and limitations

N/A

5

Course Policies and Resources

Support

This course will have an online component, which can be accessed through Sakai, OHSU’s online course management system. For any technical questions or if you need help logging in, please contact the Sakai Help Desk.

 

Hours: Sakai Help Desk is available Mon – Fri, 8 am – 9 pm and weekends 12 pm – 5 pm, Pacific Time.

Contact Information:

(Toll-free) 877-972-5249

(Web) http://atech.ohsu.edu/help

(Email) [email protected]

 

Students also have access to all of the on-line resources of the OHSU Library.

School Policies and Resources

Graduate Studies Guidelines:

Students are responsible for following all OHSU School of Medicine, Graduate Studies, and program/department guidelines & policies. For more information, please visit here. For program/department guidelines & policies, please inquiry with the program/department director and/or coordinator.

School of Medicine Conduct Policy (housed under the graduate studies guidelines section)

Students are responsible for their own academic work. Students are expected to have read and practice principles of academic honesty, as presented in the Graduate Studies Student Handbook.

The School of Medicine reserves the privilege of retaining only those students who, in the judgement of the faculty, satisfy the requirements of scholarship and clinical performance necessary to maintain the highest standards. The Student Handbook has information about academic standards and probation and dismissal policies.

Grading Criteria, Academic Standards, & Release of Final Grades:

Graduate Studies in the OHSU School of Medicine is committed to providing grades to students in a timely manner. Course instructors will provide students with information in writing at the beginning of each course that describes the grading policies and procedures including but not limited to evaluation criteria, expected time needed to grade individual student examinations and type of feedback they will provide.

All coursework applied towards degree requirements must meet the minimum cumulative grade point average of at least 3.0.

Refer to the School of Medicine Graduate Studies Forms & Policies for withdraw, incomplete, and in-progress grading standards. Final course grades will be posted with the OHSU Registrar the Monday following the last day of the term. On those occasions when a grade has not been submitted by the deadline, the following procedure shall be followed:

  1. The Department*/Program** Coordinator will immediately contact the Instructor requesting the missing grade, with a copy to the Program Director and Registrar.
  2. If the grade is still overdue by the end of next week, the Department*/Program** Coordinator will email the Department Chair directly, with a copy to the Instructor and Program Director requesting resolution of the missing grade.
  3. If, after an additional week the grade is still outstanding, the student or Department*/Program** Coordinator may petition the Office of Graduate Studies for final resolution.

*For courses that are run by a specific department.

**For the conjoined courses (course number is preceded by CON) that are run by Graduate Studies.

Graduate Studies Inclement Weather Procedures

Inclement weather procedures can be found here. In the case of inclement weather, the faculty member will email or place a voice-mail greeting on her/his office telephone number by 6:00am on the day of the clinical or class to give instructions to students about the class schedule.

Graduate Studies Copyright Information

Every reasonable effort has been made to protect the copyright requirements of materials used in this course. Class participants are warned not to copy, audio, or videotape in violation of copyright laws. Journal articles will be kept on reserve at the library or online for student access. Copyright law does allow for making one personal copy of each article from the original article. This limit also applies to electronic sources.

DMICE Communication Policy

  1. If the syllabus directs the student to contact the TA before contacting the instructor, the student should do so. Otherwise, the student should contact the instructor and allow 2 business days (not including weekends) for a response.
  2. If the student does not receive a response from the instructor within 2 business days, s/he should contact the TA (if there is one). When contacting the TA s/he should cc the instructor and Diane Doctor at [email protected].
  3. If a student does not receive a response from the TA within 1 business day (not including weekends), s/he should contact Diane Doctor at [email protected] and cc the instructor and the TA.
  4. If Diane does not reply within 1 business day (not including weekends), the student should contact Andrea Ilg at [email protected].
  5. Students having difficulties with Sakai should contact the Sakai Help Desk at [email protected] or at (877) 972-5249. Sakai help is available M-F from 8am to 10-pm and weekends from Noon to 5pm. Do not contact the instructor.

When Problems Arise

It is critical to contact the appropriate person when problems arise:

  • For basic Sakai problems and course issues (e.g., cannot log in, after-hours technical assistance, Course Materials or Forum not available/accessible during regular business hours/days), contact the Sakai Help Desk: Toll-Free - (877) 972-5249; email - [email protected] Sakai help is available M-F from 8 am to 9 pm and weekends from Noon to 5pm.

  • For questions about course content (e.g., do not understand a topic or disagree with homework quiz answer), contact the Teaching Assistant, who will be announced at the beginning of the course: go to the Email Tab after logging into the course and choose “Associate” role to send message to the TA or post a question in the Forums.

Examination Policy

It is OHSU policy that any exam offered online and worth more than 10% of the final course grade must be virtually proctored. In this course, we will be using the services of Examity, a remote proctoring services company. You will be required to schedule your exam three (3) weeks ahead of time. There is no cost to the student. More information will be provided to you regarding setup, scheduling, and requirements in the Course Materials.

Policy number: 02-70-050

Turn It In

In an effort to uphold the principles and practice of academic honesty, faculty members at OHSU may use originality checking systems such as Turnitin to compare a student’s submitted work against multiple sources. To protect student privacy in this process, it will be necessary to remove all personal information, i.e. student name, email address, student u-number, or any other personal information, from documents BEFORE submission.

Sakai and TLC Help Desk

You will learn through the Sakai learning management software at http://sakai.ohsu.edu. The online component includes reading material, lectures (including streaming presentations and handouts), project material, learning assignments, and online discussions.  If you have any technical questions or if you need help logging in, please contact the Sakai Help Desk, which is open Mon – Fri, 8 am – 9 pm and weekends 12 pm – 5 pm, Pacific Time.


Contact Information:

(Toll-free) 877-972-5249

(Web) http://atech.ohsu.edu/help

(Email) [email protected]

Online Etiquette

Please use professional etiquette when communicating with peers and the instructor. This means avoiding aggressive or offensive language, showing respect for others’ opinions and positions, and conducting yourself as if you were face to face with them. Please pay special attention to etiquette in class forums and when using email. If you notice someone violating this policy, please make the instructor and TA aware of the problem.

School Competencies

OHSU Competencies

OHSU Graduation Core Competencies

Professional Knowledge and Skills

    • Demonstrate competence in the core knowledge, skills, and practices as defined by degree programs and relevant professional licensing and credentialing boards.

Reasoning and Judgement

    • Demonstrate the ability to identify and define problems, critically compare options, make timely decisions or recommendations, identify uncertainties, and use findings to improve outcomes in light of evolving evidence.

Evidence-Based Practice and Research

    • Demonstrate the ability to access, evaluate, and apply relevant science knowledge to support evidence-based health care, disease prevention, health promotion and discovery.

Lifelong Learning

    • Demonstrate the ability to recognize gaps in knowledge and experience through informed self-assessment and reflective practices, and take actions to address those gaps.

Communication

    • Demonstrate active listening and oral and written communication skills with diverse individuals, communities, and colleagues to ensure effective, culturally appropriate exchange of information.

Professionalism and Ethics

    • Demonstrate integrity, honesty, knowledge of ethical principles and the standards of professional conduct, and the ability to apply ethical principles in clinical care, research, education or community service.

Teamwork

    • Demonstrate the abilities required to foster and work effectively within collaborative, team-based environments.

Safety and Quality Improvement

    • Demonstrate the ability to identify situations that compromise safety and participate in risk reduction and continuous quality improvement.

Systems

    • Demonstrate an appropriate understanding of evolving health care systems, health and science policy, and resource allocation in order to optimize human health and scientific discovery.

Patient/Client-Centered Care (Additionally, clinical degree program graduates will be able to...)

    • Demonstrate the ability to collaborate with diverse individuals, families, and communities to provide quality care that is respectful of and responsive to their preferences, needs, attitudes, beliefs and values.

Institutional Policies and Resources

Statement Regarding Students with Disabilities:

OHSU is committed to inclusive and accessible learning environments in compliance with federal and state law. If you have a disability or think you may have a disability (mental health, attention-related, learning, vision, hearing, physical or health impacts) contact the Office for Student Access at (503) 494-0082 or OHSU Student Access to have a confidential conversation about academic accommodations. Information is also available at Student Access Website. Because accommodations may take time to implement and cannot be applied retroactively, it is important to have this discussion as soon as possible.

Portland State students also have similar resources available via the PSU Disability Resource Center (website http://www.pdx.edu/drc ). Please contact the DRC at tel. (503) 725-4150 or email at [email protected]

Student Evaluation of Courses:

Course evaluation results are extremely important and used to help improve courses and the learning experience of future students. Responses will always remain anonymous and will only be available to instructors after grades have been posted. The results of scaled questions and comments go to both the instructor and their unit head/supervisor. Refer to Student Evaluation of Courses and Instructional Effectiveness, *Policy No. 02-50-035.

*To access the OHSU Student Evaluation of Courses and Instructional Effectiveness Policy, you must log into the OHSU O2 website.

Copyright Information:

Copyright laws and fair use policies protect the rights of those who have produced the material. The copy in this course has been provided for private study, scholarship, or research. Other uses may require permission from the copyright holder. The user of this work is responsible for adhering to copyright law of the U.S. (Title 17, U.S. Code). To help you familiarize yourself with copyright and fair use policies, the University encourages you to visit its Copyright Web Page

Sakai course web sites contain material protected by copyrights held by the instructor, other individuals or institutions. Such material is used for educational purposes in accord with copyright law and/or with permission given by the owners of the original material. You may download one copy of the materials on any single computer for non-commercial, personal, or educational purposes only, provided that you (1) do not modify it, (2) use it only for the duration of this course, and (3) include both this notice and any copyright notice originally included with the material. Beyond this use, no material from the course web site may be copied, reproduced, re-published, uploaded, posted, transmitted, or distributed in any way without the permission of the original copyright holder. The instructor assumes no responsibility for individuals who improperly use copyrighted material placed on the web site.

Syllabi Changes and Retention:

Syllabi are considered to be a learning agreement between students and the faculty of record. Information contained in syllabi, other than the minimum requirements, may be subject to change as deemed appropriate by the faculty of record in concurrence with the academic program and the Office of the Provost. Refer to the *Course Syllabi Policy, 02-50-050.

*To access the OHSU Course Syllabus Policy, you must log into the OHSU O2 website.

Commitment to Diversity & Inclusion:

OHSU is committed to creating and fostering a learning and working environment based on open communication and mutual respect. If you encounter sexual harassment, sexual misconduct, sexual assault, or discrimination based on race, color, religion, age, national origin, veteran’s status, ancestry, sex, marital status, pregnancy or parenting status, sexual orientation, gender identity, disability or any other protected status please contact the Affirmative Action and Equal Opportunity Department at 503-494-5148 or [email protected]. Inquiries about Title IX compliance or sex/gender discrimination and harassment may be directed to the OHSU Title IX Coordinator at 503-494-0258 or [email protected]

Modified Operations, Policy 01-40-010:

Students should review the Student Portal, O2, or call OHSU’s weather alert line at 503-494-9021 for the most up-to-date information on OHSU-wide modified operations which include but are not limited to delays or closures for inclement weather. For specific campus information, outside of Portland, check the following sites:

OHSU Resources Available to Students*:

Registrar’s Office
Mackenzie Hall, Rm. 1120
503-494-7800; Email the Registrar

Student Registration Information:
To Register for Classes

OHSU ITG Help Desk
Regular staff hours are 6 a.m. to 6 p.m., Monday through Friday, but phones are answered seven days a week, 24 hours a day. Call 503 494-2222.

Teaching and Learning Center
Academic Support Counseling and Sakai Course Management System, please contact the TLC Help Desk at 877-972-5249 or email TLC Help Desk

Concourse Syllabus Management
For help with accessing your Concourse Syllabus:  Please contact the Sakai help Desk for all other Concourse inquiries please visit the Concourse Tutorial Website or please contact the Mark Rivera at [email protected] or call 503-494-0934

Public Safety

OHSU Public Safety

SOU - Ashland Campus Public Safety

  • For Emergencies dial 911
  • Officer Assistance: (541) 552-6911

WOU - Monmouth Campus Public Safety

  • Emergency: 503-838-9000
  • Main Office (Open 24/7): 503-838-8481

EOU - La Grande Campus Public Safety

  • Emergency: 911
  • Camus Security Non Emergency: 541-962-3911

OIT - Klamath Falls Campus Public Safety

  • Emergency: 911 or 541-885-0911
  • Camus Security Non Emergency: 541-885-1111

*Joseph B. Trainer Health & Wellness Center
Baird Hall, Rm. 18 (Primary Care) and Rm. 6 (Behavioral Health)
503-494-8665; For urgent care after hours, 503-494-8311 and ask for the Nurse on call.
Wellness Center Information  
Wellness Center Website

*Exceptions include Public Health students who have selected PSU as their primary providers and students whose home campus is a satellite campus or online. If your home institution is not on the Portland campus, contact your home institution student support services for more information.

Ombudsman Office
Gaines Hall, Rm. 117
707 SW Gaines Street, Portland, OR 97239
503-494-5397; Contact Ombudsman; Ombudsman Website

Library: Biomedical Information Communication Center
BICC Library Hours of Operation

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