Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part G Moving from Evidence to Action
Chapter 22.8. Teachers' Guides to the Users' Guides
Peter C. Wyer, Deborah J. Cook, W. Scott Richardson, Mahmoud Elbarbary, Mark Wilson
Example 3
Topics Discussed:
clopidogrel, fluid resuscitation, mechanical ventilation, patient position, teaching issues
Excerpt:
"Learning is more effective and more likely to lead to change in behavior
when it takes place in the context in which it will be applied.7,8 It
is particularly important to center as much of the teaching of EBM in
clinical teaching settings as possible.6,9 This
requires the teacher to be skilled in each of the 3 teaching modes.An effective teaching script encompasses content adapted to the
teaching venue, time period, and competing demands, as well as the learners' previous
knowledge, readiness, and inclination to absorb new content. Irby13 posited
that the ability to modify and adapt a teaching script to learner
needs and knowledge level while being attentive to the needs posed
by the patient problem at hand is the hallmark of a master clinical
teacher.ICU nurse regarding recently admitted mechanically
ventilated patient: "I am surprised to find that Mrs Richards
has been placed at 45 degrees from the horizontal. Someone mentioned
this is to prevent pneumonia." Underlying questions:
In critically ill patients, what is the effect of semirecumbent
positioning on the incidence of pneumonia?ICU resident: "Mr Jones is 1 day post–abdominal
aortic aneurysm surgery. His blood pressure and urine output are
on the low side, with episodes of hypotension. We gave him 1 L of
albumin and 1.5 L of normal saline. Should we give him only colloids today?" Underlying
question: In critically ill patients with hypotension, what is the
effect of colloids vs crystalloids on mortality?Mr Smith has stable angina, peptic ulcer disease,
and a recent history of gastrointestinal bleeding while receiving
aspirin. You are Mr Smith's primary care physician and
discussing the choice of antiplatelet agent with his gastroenterologist,
who is a member of your group and is inclined to switch his medication
to clopidogrel...."
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