Evidence-Based Decision-Making as a Practice-Based Learning Skill: A Pilot Study

• Published in: Academic psychiatry Vol. 36; no. 2; pp. 104 - 109
• Main Authors: Falzer, Paul R., Garman, D. Melissa
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.03.2012; American Psychiatric Publishing, Inc; Springer Nature B.V
• Subjects: Adult; Algorithms; Anxiety; Behavioral Objectives; Clinical Competence; Competence; Coping; Creativity; Decision Making; Decision Support Techniques; Educational objectives; Evaluation Methods; Evidence; Evidence Based Practice; Evidence-Based Medicine - methods; Factor Analysis; Family Involvement; Female; Graduate Medical Education; Guidelines; Humans; Internship and Residency - methods; Male; Medical Education; Medical Evaluation; Medicine; Medicine & Public Health; Mental Disorders; Original Article; Patients; Perception; Physicians; Pilot Projects; Principals; Problem-Based Learning - methods; Psychiatry; Psychiatry - education; Rating Scales; Schizophrenia; Schizophrenia - therapy; Tests; Trainees; Training Objectives; Vignettes; Volunteers; Academic Psychiatry; Schizophrenia; Clozapine; Treatment Recommendation; Aripiprazole
• ISSN: 1042-9670; 1545-7230
• DOI: 10.1176/appi.ap.10050082

Objectives As physicians are being trained to adapt their practices to the needs and experience of patients, initiatives to standardize care have been gaining momentum. The resulting conflict can be addressed through a practice-based learning and improvement (PBL) program that develops competency in using treatment guidelines as decision aids and incorporating patient-specific information into treatment recommendations. This article describes and tests a program that is consistent with the ACGME’s multilevel competency-based approach, targets students at four levels of training, and features progressive learning objectives and assessments. Methods The program was pilot-tested with 22 paid volunteer psychiatric residents and fellows. They were introduced to a schizophrenia treatment guideline and reviewed six case vignettes of varying complexity. PBL assessments were based on how treatment recommendations were influenced by clinical and patient-specific factors. The task permitted separate assessments of learning objectives all four training levels. Results Among the key findings at each level, most participants found the treatment guideline helpful in making treatment decisions. Recommendations were influenced by guideline-based assessment criteria and other clinical features. They were also influenced by patients’ perceptions of their illness, patient-based progress assessments, and complications such as stressors and coping patterns. Recommendations were strongly influenced by incongruence between clinical facts and patient experience. Conclusion Practical understanding of how patient experience joins with clinical knowledge can enhance the use of treatment guidelines as decision tools and enable clinicians to appreciate more fully how and why patients’ perceptions of their illness should influence treatment recommendations. This PBL program can assist training facilities in preparing students to cope with contradictory demands to both standardize and adapt their practice. The program can be modified to accommodate various disorders and a range of clinical factors and patient-specific complications.