Good questions are the backbone of both practising and teaching EBM, and patients serve as the starting point for both. The challenge to the teacher is to identify questions that are both patient-based (arising from the clinical problems of a real patient under the learner’s care) and learner-centred (targeted at the learning needs of this learner).
One of the most important aspects of this task is asking focused clinical questions, Once you and your learner/s have formulated an important question, how are you going to keep track of it and follow its progress towards a clinically useful answer? It may be just one of several questions you formulate during a single encounter, and it m y not be answered for days. One tactic we have used for keeping track is the use of educational prescriptions (Rx), which help both teachers and learners in five ways:
- it specifies the clinical problem that generated the question;
- it states the question, in all of its key elements;
- it specifies who is responsible for answering it;
- it reminds everyone of the deadline for answering it (taking into account the urgency of the clinical problem that generated it);
- it reminds everyone of the steps of searching, critically appraising, and ultimately relating the answer back to the patient.
Forming questions is the essential initial step in learning how to practice EBM. As such, it ought to be central to the everyday care of patients.
Using educational prescriptions in teaching
The number of ways in which educational prescriptions can be used in teaching is limited only by your imagination and the opportunities you have for teaching. They have been incorporated into familiar clinical settings from work rounds and attending/consulting rounds to morning report and noon conferences. Although some teachers set aside special times for filling educational prescriptions, we favour dispensing them as part of the everyday routine.
Therefore, when setting or presenting a patient, you can think about the educational prescription you would like to write for yourself in order to better understand the patient’s pathophysiology, clinical findings, differential diagnosis, diagnosis, prognosis, therapy, prevention, or another issue in order to become a better clinician. For even more fun, try having your learners write educational prescriptions for you.
Date and Place to be filled:
The Patient:
The Intervention
(therapeutic, diagnostic, prognostic, causal):
(vs Alternatives)
The Target Outcome/s
(a change in the risk or likelihood of):
The Learner:
Presentations will cover:
- HOW you found what you found
- WHAT you found (the bottom line)
- the VALIDITY and APPLICABILITY of what you found (the critical appraisal)
- How what you found will ALTER your MANAGEMENT of such patients
- How WELL you think you DID in filling this Rx.