3/2/2012

PEARLS OF PRECEPTING 2012

Stephen D. Laird, D.O., MPH
Associate Dean for Academic Affairs
John H. George, Ph.D.
Associate Dean for Curriculum
Robert W. Baer, Ph.D.
Professor, Physiology

OBJECTIVES

• Asking Clinical Questions

• Web-based Precepting Tool

• What Is Good Evidence?

• How to find it

• Question Wrap Up

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AUDIENCE

• Medical Students Years 1 &2 - Pre-Clinical

• Medical Students Years 3 & 4 - Clinical

• Residents

• None of the Above

TYPES OF QUESTIONS

• Background Question

• Foreground Question

CASE

• S: 10 year old male with a two day history of sore throat. He

denies a cough or runny nose. His mom states his oral
temperature was 101.5 degrees F. No other family members are
ill.

• O: Not toxic in appearance, Membranes are moist. Ears and TM

unremarkable, Throat is erythmatous with white patches
around the tonsillar areas. Positive lymph nodes anteriorly.
H: RRR without murmur, L: CTAB, Abd.: soft and nontender,
Skin: no rashes, MSK exam: acute tissue texture abnormalities
noted bilaterally T1-4 & C1-3

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BACKGROUND QUESTIONS

• Who?
• What?
• When?
• Why?
• Where?

CASE

• S: 10 year old male with a two day history of sore throat. He

denies a cough or runny nose. His mom states his oral
temperature was 101.5 degrees F. No other family members are
ill.

• O: Not toxic in appearance, Membranes are moist. Ears and TM

unremarkable, Throat is erythmatous with white patches
around the tonsillar areas. Positive lymph nodes anteriorly.
H: RRR without murmur, L: CTAB, Abd.: soft and nontender,
Skin: no rashes, MSK exam: acute tissue texture abnormalities
noted bilaterally T1-4 & C1-3

FOREGROUND QUESTIONS

• Ask for specific knowledge to inform clinical

decisions or actions

• Four essential components

• Patient and/or problem
• Intervention (or exposure)
• Comparison, if relevant
• Clinical outcomes, including time if relevant

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PATIENT PERSPECTIVE

• What do patients care about?

• Patients don’t care about whether a medication will
lower their blood pressure but rather they want to know
“will it help to increase the length of my life or improve
the quality of my life?”
• Does the evidence affect:
• Mortality
• Morbidity
• Quality of Life

POEM

Patient-Oriented
Evidence
that Matters

Matters to the clinician, because if valid, it will require a

change in practice
Shaughnessy AF, Slawson DC, Bennett JH. Becoming an Information Master: A
Guidebook to the Medical Information Jungle. The Journal of Family Practice
1994;39(5):489-99.

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RELEVANCE – TYPE OF EVIDENCE

• POEM: Patient-Oriented Evidence that Matters

• Mortality, Morbidity, Quality of Life
• Longer, better or both

• DOE: Disease-Oriented Evidence

• Pathophysiology, Pharmacology, Etiology

PICO

(P) Population/Patient
(How would I describe a group of patients similar to mine?)

(I) Intervention
(A cause, prognostic factor, or treatment)

(C) Comparison
(What is the main alternative to compare with the intervention?)

(O) Outcome
(What can I hope to accomplish? Patient perspective)

PICO QUESTION

• QUESTION: How should I treat non-stop hiccups in a

patient with HIV?
P In patients with HIV disease and non-stop hiccups
I What works
C As compared with nothing, which is what I’m doing now.
O To permanently stop these hiccups

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PICO QUESTION

• I want articles on the use of hormone replacement

therapy after complete hysterectomy for treatment
of uterine cancer.

P In women who have had a hysterectomy for treatment of

uterine cancer
I Is hormone replacement therapy
C As safe and as effective as not using it
O To control symptoms of menopause