EWMA Educatinal Develpment Prgramme Curriculum Develpment Prject Educatin Mdule: Seeking and Appraising Evidence Latest review: August 2012
Educatin Mdule: Seeking and Appraising Evidence ABOUT THE EWMA EDUCATIONAL DEVELOPMENT PROGRAMME The Prgramme is designed t assist students and healthcare prfessinals wh wrk with patients with wunds and related skin cnditins and wish t develp and/r increase their knwledge and skills in rder t meet patient needs. Overall, the Prgramme aims t: Prvide students and healthcare prfessinals with the knwledge and skills t equip them t perfrm their rle in the delivery f ptimal wund care. Prvide cntemprary, interdisciplinary, prduct/brand neutral wund management educatin that is endrsed by EWMA. Prvide quality standards against which ther rganisatins can evaluate existing wund management prgrammes. Achieve Eurpean acceptance by develping an educatinal framewrk that is in line with Eurpean Cmmissin educatinal initiatives in rder t disseminate best practice in wund care. ABOUT THE CURRICULUM DEVELOPMENT PROJECT The Curriculum Develpment Prject is at the heart f the Educatinal Develpment Prgramme. The aim f the Prject is t develp a flexible curriculum, cnsisting f a number f mdules. All mdules are based n a standard template but individually fcused n a specific aspect f wund management. Each mdule is develped by a small grup cnsisting f members f the EWMA Educatin Cmmittee and/r affiliated wund care key specialists. Fr an updated list f the currently available mdules please visit the educatin sub page at www.ewma.rg. ABOUT THIS MODULE The Seeking and Appraising Evidence mdule aims t: Prvide infrmatin n accessing relevant evidence t answer questins related t a range f issues imprtant t wund management Braden participants knwledge f relevant electrnic databases and strategies t search these effectively Intrduce a range f methds t critically review the evidence fund t further develp skills in critical appraisal Distinguish between types f critical appraisal questins asked dependent n the study design Page 2 f 6
Educatin Mdule: Seeking and Appraising Evidence MODULE CONTENT 1. Elabrating Bdy Eurpean Wund Management Assciatin (EWMA) 2. Date f prductin f mdule March 2009 3. Latest review date August 2012 4. Mdule intended learning utcmes This mdule prvides pprtunities fr health prfessinals t develp and demnstrate knwledge and understanding, skills and ther attributes in the fllwing areas: A. Intellectual Skills Knwledge and Understanding Participants will have knwledge f: 1. The difference between a systematic review, a meta-analysis and an pinin based review 2. A range f paper based and electrnic resurces available relevant t wund management 2. The Literature Search prcess, including defining and limiting the scpe f a search, relevant search terms, and MESH terminlgy 3. Levels f evidence and hw these relate t different research designs used 4. Types f questins (established checklists) a reviewers needs t ask when establishing the quality f the evidence acrss a range f research designs frm qualitative t quantitative 5. Varius ways f presenting and analysing data acrss the spectrum f different research designs frm qualitative t quantitative B. Practical Skills Skills and Attributes: Participants will be able t: 1. Frmulate answerable clinical questins relevant fr wund management 2. Carry ut a search f electrnic databases t find the best evidence n a given tpic 3. Critique a relevant research paper in terms f the quality f the research undertaken 3. Assess the results f a paper fr generalisability t ther areas 4. Recrd and present a critical appraisal f a paper 5. Teaching/learning methds & strategies Acquisitin f 4.A & 4.B (see abve) is thrugh a cmbinatin f lectures, small grup wrkshps and learning in practice thrughut the mdule. There is als the pssibility f using e-learning in Page 3 f 6
Educatin Mdule: Seeking and Appraising Evidence cmbinatin with traditinal learning methds. Thrughut, the learner is encuraged t undertake independent study bth t supplement and cnslidate what is being taught and t braden individual knwledge and understanding f the subject. 6. Assessment methds Assessment methds will need t include pprtunities t seek ut literature relevant t a particular aspect f wund management and critically evaluate literature based n research that uses a range f methds. Understanding may be assessed in a variety f ways i.e. pen discussin, frmal written exercises, practice wrk-bks, exercises in critical thinking, critique f specific papers. Thrughut, the learner is expected t cnslidate the develpment f practical skills / management skills in the clinical setting. 7. Unit cntent The steps needed t practice evidence based care: There are five main steps t practising evidence based medicine: 1 Identify knwledge gaps and frmulate a clear clinical questin (e.g., PICO methd) Search the literature t identify relevant articles Critically appraise the articles fr quality and the usefulness f results; always questin whether the available evidence is valid, imprtant and applicable t individual patients / client grups Implement clinically useful findings int practice Make recmmendatins fr future research Finding the evidence 1. Searching fr guidelines e.g. NICE, Natinal Library fr Health, prfessinal bdies (e.g. relevant specialist site such as the Ryal Cllege f Nursing). 2. Searching fr systematic reviews and meta-analyses, e.g. Cchrane database, Janna Briggs system. 3. If n systematic reviews r meta-analyses are available, lk fr primary research, e.g. PubMed. 4. If n research is available, cnsider general internet search, e.g. Ggle, r discuss with a lcal specialist (at this level beware pr quality infrmatin frm the internet r individual persnal bias frm even the mst respected specialist). Student shuld becme familiar with relevant databases, fr example: The Natinal Library fr Health which prvides access t a range f medical search sites, including PubMed, Medline, EMBASE, Bandlier, Yrk Centre fr Review and Disseminatin and the Cchrane database. Natinal guidelines and guidance sites include the Natinal Institute f Clinical Excellence (NICE) and the Scttish Intercllegiate Guidelines Netwrk (SIGN). Guidance n many tpics is als available at the Clinical Knwledge Summaries (frmerly PRODIGY) website. Evaluate the evidence Page 4 f 6
Educatin Mdule: Seeking and Appraising Evidence A review f the different ways in which evidence is graded (see belw) An verview f the different checklists that are available t assess the quality f studies The curse shuld include an intrductin t a range f research designs and methds, including meta analysis, randmised cntrlled trials, chrt studies, case-cntrl methds, lngitudinal and crss-sectinal designs, case studies and case reprts, surveys, qualitative interviews. Questins related t the ethics f the study and the rle f funding surces shuld be debated Grading f evidence A range f methds exist t grade evidence t help and supprt clinical decisins; the students shuld be intrduced t several f these. Fr example: Ia: systematic review r meta-analysis f randmised cntrlled trials Ib: at least ne randmised cntrlled trial IIa: at least ne well-designed cntrlled study withut randmisatin IIb: at least ne well-designed quasi-experimental study, such as a chrt study III: well-designed nn-experimental descriptive studies, such as cmparative studies, crrelatin studies, case cntrl studies and case series IV: expert cmmittee reprts, pinins and/r clinical experience f respected authrities Grading f recmmendatins A: based n hierarchy I evidence B: based n hierarchy II evidence r extraplated frm hierarchy I evidence C: based n hierarchy III evidence r extraplated frm hierarchy I r II evidence D: directly based n hierarchy IV evidence r extraplated frm hierarchy I, II r III evidence A simpler system f A,B r C is recmmended by the US Gvernment Agency fr Health Care Plicy and Research (AHCPR): A: requires at least ne randmised cntrlled trial as part f the bdy f evidence. B: requires availability f well-cnducted clinical studies but n randmised cntrlled trials in the bdy f evidence. C: requires evidence frm expert cmmittee reprts r pinins and/ r clinical experience f respected authrities. Indicates absence f directly applicable studies f gd quality. Guideline recmmendatin and evidence grading Students shuld be intrduced t new methds t grade evidence, e.g., Guideline Recmmendatin and Evidence Grading - GREG: Evidence grade: I (High): the described effect is plausible, precisely quantified and nt vulnerable t bias Page 5 f 6
Educatin Mdule: Seeking and Appraising Evidence II (Intermediate): the described effect is plausible but is nt quantified precisely r may be vulnerable t bias III (Lw): cncerns abut plausibility r vulnerability t bias severely limit the value f the effect being described and quantified Recmmendatin grade: A (Recmmendatin): there is rbust evidence t recmmend a pattern f care B (Prvisinal recmmendatin): n balance f evidence, a pattern f care is recmmended with cautin C (Cnsensus pinin): evidence being inadequate, a pattern f care is recmmended by cnsensus Other systems such as GRADE (Guyatt et al 2008) r the AGREE Tl (www.agreecllabratin.rg) shuld als be cnsidered as part f evaluating the evidence that underpins guidelines as well as the quality f the system used t develp relevant guidelines. 8. Unit specific learning resurces Bks/Bk chapters Greenhalgh, T. (3 rd Ed.) (2006). Hw t Read a Paper: the Basics f Evidence Based Medicine. Blackwell Publishing Ltd. Oxfrd. Jurnals Papers Glasziu P, Vandenbrucke J P and Chambers I (2004) Assessing quality f research. BMJ. 328 (7430) 39-41 Gttrup F, Apelqvist J, Price P (2010) Outcmes in cntrlled and cmparative studies n nnhealing wunds: recmmendatins t imprve the quality f evidence in wund management. Jurnal Wund Care, 19 (6): 237 268 Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Schünemann HJ (2008) GRADE: what is quality f evidence and why is it imprtant t clinicians? BMJ, 3May, Vl 336: 995-998 Sackett DL, Rsenberg WMC, Muir Grey JA et al (1996). Evidence based medicine: what it is and what it isn t. BMJ 312: 71-72. Sandelwski M (2004). Using Qualitative research. Qualitative health research 14 (10):1366-1386. Useful Web Links www.shef.ac.uk/scharr www.cardiff.ac.uk/insrv/resurces/guides/wcm004.pdf www.agreecllabratin.rg/ Page 6 f 6