International Contest on Evidence Based Medicine

November 24th, and 25th, 2007 at Taipei, Taiwan

To encourage the practice of Evidence Based Medicine (EBM) among healthcare professionals, the Taiwan Society of Internal Medicine is honored to host the International EBM Contest on November 24th, and 25th, 2007 at Taipei, Taiwan. We sincerely welcome doctors who areinterested in EBMfrom all medical fields to register for the contest.

Contest at a Glance

The contest consists of 3 preliminary sessions and a final session. Each session lasts about 3 hours. During each preliminary session, competition teams are asked to create PICOs from the scenarioprovided by the EBM Contest Taskforce in 20 minutes. In the next 90 minutes, the Taskforce will announce one PICO for all teams to perform literature search, literature appraisal and to synthesize power point presentation slides. The presentation should include literature searching strategies, explicit criteria for literature appraisal, summary of literatures, final recommendations from the evidence, and feedbacks to patients in a way easily understood from lay persons. Each team has 12 minutes to present their work. After a 20-minute break, the contest judges will announce one winner for each preliminary session. Winners of the three preliminary sessions will enter the final session for the championship.

Time:

Preliminary Session 1: 9:00am to 12:00pm, Nov., 24th, 2007

Preliminary Session 2: 14:00am to 17:00pm, Nov., 24th, 2007

Preliminary Session 3: 9:00am to 12:00pm, Nov., 25th, 2007

Final Session: 14:00am to 17:00pm, Nov., 25th, 2007

Location:

304Lecture Hall at the National Taiwan University College of Medicine

Team Member Qualification:

Each team consists of 3 members with at least one physician (intern, resident, or attending). Other team members can be medical students, physicians or other healthcare professionals (nurses, pharmacists, occupational therapists, etc…).

Prize:

Winner of Preliminary Session: U.S. Dollar $500＆ Trophy

Winner of the Final Session: U.S. Dollar $1,000＆ Trophy

Registration:

Each team is required to submit Registration Formto the International EBM Contest Workforce by Sep 30th, 2007.

Technical Support:

Each team member is encouraged to bring his/her own laptop computer with wireless connection capacity to the contest. Each team needs to come to the competition location ONE HOUR before each session to set-up the wireless connection. The technical support team will be on-site to solve any information technology related issue. The Taskforce will also prepare several laptop computers for contestants to use.

There is no limitation on the searching engine as long as the team members have access to the database. The Taskforce will provide full-text access to several widely used medical databases through connections to the National Taiwan University Medical Library (NTUML). These databases include but not limited to: Medline, Pubmed, UpToDate, MDconsult, and Cochrane Library.

Scenario Example:

As a primary care physician, you took care of an 80 year-old Chinese woman with 20 years of type 2 diabetes (with documented retinopathy, neuropathy and proteinuira), hypertension, dyslipidemia, and history of myocardial infarction about 6 months ago. She also suffered from irritable bowel syndrome for many years with abdominal cramping and alternating constipation and diarrhea. Her current medications included metformin 100mg po bid, glyburide 10mg po bid, valsartan 160mg po qd, metoprolol sustained release 100mg po qd, trichlormethiazide 2mg po qd, enteric-coated aspirin 100mg po qd, rosuvastatin 5mg po hs, and psyllium 1 tsp tid

She is 150 cm tall and weighs 70 kg. On exam, her blood pressure was 128/72 mmHg. General exam was not remarkable except decreased sensation on bilateral feet with microfilament and 1+ pitting edema over both ankles. Recent blood works showed HbA1c of 10%, LDL 75 mg/dl, HDL 40 mg/dl, TG 120 mg/dl, Cre 0.8 mg/dl, and Hb 12 g/dl.

She said that she took all her medications faithfully and tolerated current medications well, followed suggestions from the dietician she met 3 months ago, and walked 30 minutes every night after dinner, and lost 3 kilograms in the last 3 months. She was aware that her sugar control was not satisfactory,because her home pre-meal glucose readings were usually above 200 mg/dl. You and the patient were not satisfied with the poor glycemic control.

What would be your next step to improve her glycemic control?

International EBM Contest

Recommended evaluation criteria

PICO 15%

Goal of this section:

The first step in applying evidence-based medicine (EBM) is to develop a clear idea of what type of information we are seeking. Using a stepwise process "PICO" helps convert the clinical scenario into a searchable (and hopefully answerable) question in order to find relevant articles in EBM resources that generate useful information to solve the central issue(s) in the scenario.

Evaluation:

  1. P: Patient/population

Assessment: Ability to describe a group of patients similar to the one in question (e.g., important characteristics of the patient, including primary diseases, age, sex, race, other co-existing medical conditions, etc.)

  1. I: Intervention

Assessment: Ability to specifically describe the main treatment, prognostic factor, diagnostic test or exposure about the specific group of patients

  1. C: Comparison

Assessment: Ability to specifically describe the main alternative (e.g., nothing, placebo or another intervention) to compare with the intervention

  1. O: Outcome

Assessment: Ability to specifically describe the effect(s) of the intervention and the alternative (e.g., adverse reactions of drugs, mortality, hospitalizations, quality of life, etc.)

Literature search strategy and results 20%

Goal of this section:

Based on PICO, searching strategies are employed to discover the most relevant literature articles regarding the diagnosis, etiology, prognosis, or therapy of a specific disease or condition of the scenario.

Evaluation:

  1. Formulating the strategy (50% of this section):

Terms selection (30%): search the diseases or disorders with possible appropriate terms or subheadings.

Combination of the terms (10%): using the Boolean operators to combine/exclude the final subject search statement

Focus (10%): Limit the results to the appropriate publication type, language and human.

Filters or command (extra bonus up to 20%): appropriate use of command or filters to enhance efficiency can get bonus score.

  1. Result of the search(total 50% of this section)

Specificity (25%): The results are focused and relevant to the clinical questions with relatively fewer numbers.

Comprehensiveness (25%): There are very few relevant ones that may be missed by the strategies.

Literature appraisal 30%

Goal of this section:

The literature articles selected from the strategic searching are further critically appraised on the issues important for applying the results to the scenario.

The appraisal should be based on overall evidence, instead of one single study, in the issues of population selection, implementation of intervention and comparison, appropriate methodology, description of results, discussion and conclusions. The results are used to guidethe participants’feedback to scenario. Evaluation of the baseline risks and trade-off between benefit and harm are crucial. Evaluation scores are to make a systemto grade thelevel of evidence and the strength of recommendation which is still not a consensus.Therefore, the followings are for reference. In this section, we encourage use of standardized method to designate quality and strength of the evidence. Example is shown in the table below. However, we discourageuse of unpublished grading system created by particular teams.

Evaluation:

(1) Literature appraisal (50% of this section)

For each study, please consider population (including and excluding criteria), intervention and comparison, potential bias, confounding factors, statistical power, generalizability, and limitations if possible.

(2) Levels of evidence (50% of this section)

Please consider total number of studies identified and theirstudy design, overall quality, consistency of results across studies, directness or relevance of the population, outcomes, intervention, and comparison

Summary, presentation, and feedback 30%

Goal of this section:

This section aims to evaluate the ability to summarize the results of the entire work in the process of solving problems arising from the given scenario. Presentation and feedback to the audience are the keys in communication with clinical patients, which determine the final achievement derived from EBM.

Evaluation:

Summary (1/3 of this section)

Required:

Brief the followings in powerpoint or other documents that is used to present to the audience.

  1. Case & PICO
  2. search process
  3. search result
  4. literature appraisal
  5. summary & conclusion

Assessment:

  1. summary structure
  2. thinking process
  3. rationale
  4. comprehensiveness
  5. relevance

Presentation (1/3 of this section)

Required:

Oral presentation of the summary materials within 12 minutes to the audience

Assessment:

Reasonable oral presentation and explanation of the entire work based on the summary materials to the audience

Feedback (1/3 of this section)

Required:

Each team is encouraged to use creative methods including role plays, tables, posters, etc, to effectively deliver the recommendations for the scenario to lay persons .

Assessment:

Ability and extent of translation from literature search, appraisal, and summary to oral communication and reasonable recommendation to the patient (the audience)

Audience Scoring 5%

Audience at each session are asked to use electronic devices to score the performances of competition teams after listening to their presentations.

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