Guidelines for Presenting Residents

Guidelines for the Evidence Based Medicine (EBM) Hour

 

Goal: To discuss the evidence for or against various emergency medicine practices by deriving clinically relevant questions utilizing independent review of multimedia, as in podcasts or videocasts, prior to a residency based group critical discussion of the primary literature referenced within the multimedia source.

 

Ideally, the questions posed and answered will be those that the learner can apply the very next shift, as in those that are relevant and impact daily clinical practice. Explicit effort will be made to include “landmark papers” within these discussions. The subjects covered in the EBM hour are not required to concur with the subject matter of the concurrent module, although this is preferable.

 

Contacts: If there are any issues, comments, or questions, please email the faculty leaders of the EBM hour, Scott Dresden (s-dresden@northwestern.edu), or Mark Courtney (dmarkcourtney@gmail.com).

 

Format, expectations, and responsibilities: The EBM hour will assume the following format in an effort to facilitate the expansion of knowledge base while simultaneously improving EBM literacy:

2 weeks prior to the EBM hour at conference, residents will be emailed a link to a podcast, along with 2 pieces of primary literature for review. If the podcast is lengthy, as in greater than 30 or 40 minutes, the specific time marks at which the relevant information is discussed will be provided.

Residents should be prepared to summarize the podcast and primary literature review during the EBM hour.

The EBM hour will consist of presentations from PGY 1, 2, and 3 residents.

The format of the presentations will be as follows:

PGY-3: Introduce the topic and podcast – 3 slides

PGY-1: Introduce a methods topic relevant to the primary articles chosen – 5 slides

PGY 1 & 2: Each introduce the primary research article which they have been assigned – 7 slides

 

A suggestion for slide use for primary research articles:

The goal of this presentation is to be interactive.  Limit the words on the slides, figures are helpful: Prior to diving into the discussion, ask a member from the audience to summarize the paper in 1 minute or less

1) review key points related to your topic discussed in podcast (direct quotes preferred)

2) Paper methods

3) Key results

4) Paper conclusions – direct quote preferred

5) Internal validity

6) External validity

7) conclusions/take home points

Keep slides 2-4 simple/to the point, what readers must know about the paper

Slides 5 and 6should be the ‘discussion’ slides w/ audience participation driving the dialogue (i.e. is this internally valid and data/study to be trusted AND is the paper generalizable/applicable to our practice environment).  This is a good time to bring up questions, rather than give the answers

-For each month, the responsibilities for each presenter are:

 

PGY-3:

-Derive and pose a clinical question for review and provide a multimedia source that addresses this question. The expectation is that the multimedia source is mainstream and provides literature based references for their discussion. The selected clinical question does not have to be the entire focus of the multimedia source, and the clinical question can be formulated in reverse. For example, if you have a podcast that you have listened to and find relevant and would like to discuss, generate a clinical question from the podcast and select the most relevant literature from the discussion.

-Find two references from the multimedia source, or related to it, to discuss at conference. Distribute the source and papers as described below in the deadlines section.  Work with Scott Dresden and Mark Courtney on assigning the paper to the PGY1&2s.

-Example: You listen to a podcast about subarachnoid hemorrhage that you think is a good overall review, poses interesting questions, and has references that you think are appropriate for EBM discussion. You come up with this case scenario: A 60 year old male with HTN comes in with a sudden onset worst headache of life that began 4 hours prior to arrival. Based on the content of the podcast, you derive the clinical question, “What is the utility of CT, CTA, and LP in diagnosing subarachnoid hemorrhage?”. It can also work in reverse, i.e. pose a question, find the podcast and references, etc. You find the 2 most relevant articles from the discussion, and select them for review.

-You are expected to be the leader for the individual month, meaning coordination between the junior residents, review of their slides, and ensuring adherence to the slide guidelines above.

-If the multimedia presentation is lengthy, as in greater than 30 or 40 minutes, it is your responsibliity to find the relevant time marks at which the relevant information is discussed.

-For the presentation:

-At the beginning of the EBM hour, introduce the topic generally (epidemiology, morbidity/mortality, etc), then describe a clinical case scenario that raises the clinical question, and explicitly state the clinical question that will be addressed. The method best suited for stating clinical questions during the presentation can be found at: http://ktclearinghouse.ca/cebm/practise

-Briefly discuss the overall quality of the multimedia source in terms of who the presenters are, where they work and their credentials, their use of data versus anecdotal evidence using direct quotations, and any positive or negative aspects of the formatting.

PGY-2:

-Master the information presented in the multimedia source and your assigned piece of literature. You will be emailed the monthly clinical question and and the papers by the pgy-3 resident as outlined below in the deadlines section. You are responsible to present one of the two assigned pieces of literature at conference.  You should have working knowledge of the other paper discussed to be able to reference it in your presentation as necessary.

-For the presentation:

-Facilitate discussion of your assigned piece of literature in terms of its methods, results, conclusions, and internal or external validity.  Work to encourage audience participation of each section.  Ask an audience member to describe what they thought the most important parts of the methods to understand were, ask another audience member to describe the key results.  You should have your own responses ready to agree or disagree with the audience, you will be the expert on this paper, but people will have their own opinions.  Discuss the relevance of the paper in relation to the posed clinical question.

 

PGY-1:

-Same as PGY-2 however, you will also be in charge of a “methods primer.”  With the help of Scott Dresden and/or Mark Courtney, you will pick a specific method (ex: randomized control trial study design, or t-test) to review and understand fully for the conference.  You should give a quick (5 minute) lesson on the method chosen.  This usually should fall before the discussion of the 2 primary articles, and after the PGY-3’s discussion of the multimedia source.

Deadlines:

Generally, 2 weeks prior to the EBM hour monthly lecture, the entire residency will be mailed out a link to a multimedia source, i.e. a podcast or videocast, and 2 pieces of selected literature referenced within or relevant to that discussion.

Individual resident deadlines

 

PGY-3:

-Review both your and the junior resident deadlines as below

-No later than 4 weeks prior to the EBM conference date, a clinical question must be formulated, and a link to a multimedia source with along with 1-2 selected pieces of literature must be emailed to s-dresden@northwestern.edu and dmarkcourtney@gmail.com

-3 weeks prior to the EBM conference date, the selected papers and multimedia source must be emailed out to the junior residents who will be presenting at conference.

-2 weeks prior to the EBM conference date, the multimedia source and references will be mailed out to the residency.

-1 week prior to the EBM conference date, email your powerpoint slides to Scott Dresden and Mark Courtney for review.  If you would like to review the PGY 1&2’s slides, set a deadline with them so that the slides can be forwarded to Scott & Mark 1 week prior to the EBM date.

-2 days prior to the EBM conference date, you and the PGY1&2 should receive feedback on your slides and work to incorporate the feedback and combine the slides into a single powerpoint presentation.

It is your responsibility to formulate deadlines for the junior residents to get you their slides and to combine them in a single powerpoint to meet this deadline. You might want to arrange for an advance meeting with both of the junior residents to discuss the papers, the clinical question, and the make sure that the junior residents are aware of their specific deadlines.

 

PGY-2:

-No later than 3 weeks prior to the EBM conference date, you will be emailed the selected clinical question, papers, and multimedia source for review.

-The pgy-3 resident will email you the specific deadline by which they expect to have your finalized slides.

– 1 week prior to the EBM conference your slides should be forwarded to Scott Dresden and Mark Courtney.  You should be prepared to receive suggestions 2 days prior to your EBM conference date.

 

PGY-1:

-No later than 3 weeks prior to the EBM conference date, you will be emailed the selected clinical question, papers, and multimedia source for review.

-The pgy-3 resident will email you the specific deadline by which they expect to have your finalized slides.

– 1 week prior to the EBM conference your slides should be forwarded to Scott Dresden and Mark Courtney.  You should be prepared to receive suggestions 2 days prior to your EBM conference date.

Please have fun and remember that the EBM hour will only be as good as the amount of effort that the participating residents put into it!

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