Evidence-Based PPT Presentations for

the Department of Family Medicine

Sharon E. Tabachnick, PhD, MSLS

Education Coordinator
Department of Family Medicine
stabachn@uthsc.edu
Office: 901-448-7574
Mobile: 901-463-0261
Source: Florida State University College of Medicine
http://med.fsu.edu/index.cfm?page=medicalinformatics.ebmTutorial
Definitions
• Evidence-Based Medicine is “a systematic
approach to clinical problem solving which
allows the integration of the best available
research evidence with clinical expertise and
patient values.”(Sackett DL, Strauss SE, Richardson WS,et al. Evidence-based
medicine: how to practice and teach EBM. London: Churchill-Livingstone,2000)

• Evidence-Based Practice is “making a

conscientious effort to base clinical decisions on
research that is most likely to be free from bias,
and using interventions most likely to improve
how long or well patients live."
(Mark H. Ebell, MD, MS, Professor, University of Georgia, Editor-in-Chief, Essential Evidence Plus)
 What is expected of an EBM Presentation in FME?
1. Choose a topic of interest within the field of Family Medicine to present
in the “Journal Club” format.
2. Choose a partner (we encourage team work in pairs).
3. Take into account the three elements of EBM & the grading rubric.
4. Reference a variety of sources, such as high quality primary and
secondary (i.e. review) types of research, by using indexes such as the
Pubmed index (www.pubmed.gov), www.scholar.google.com, etc.
5. Pick one high quality PRIMARY QUANTITATIVE piece of research that
you think is important for your presentation, and explain what type of
research it is, what are its strengths & limitations, and whether or not
doctors do/should follow its recommendations (Journal Club format)
6. The research design in #3 above may be experimental, quasi-
experimental, or non-experimental (i.e. cohort, case-control, etc.). It
must use INFERENTIAL STATISTICS (e.g. t-test, chi square, etc.).
7. Use the IMRAD Format (Introduction, Methodology, Results, and Discussion).
8. If choosing clinical trial (entirely optional): Phase III or IV studies only.
 To Gauge Strength of Evidence, use the
IMRAD Format
√I- Introduction. Report the background/context (5 min.)
√M- Methodology of the focus article. Examine the methods
including ethics, internal validity, congruence,
justification, explanation, controlling for confounding
variables (esp. in quasi- and non- experimental designs).
√R- Results. Inspect the results of the focus article &
determine if they are reported correctly & if they are
congruent w/ the rest of the study.
A- And
√D- Discussion. Take-home message. Determine what all this
means, including internal & external validity.
Note: Based on the Uniform Requirements for Manuscripts (URM) of the ICMJE
(International Committee of Medical Journal Editors, http://www.icmje.org/urm_full.pdf)
 Research Terminology for Quantitative
Research
• Randomized-Experimental: Random assignment (Random
Selection NOT necessary) to groups, manipulated IV, inferential
statistics. This is the gold standard in medical research.
• Quasi-Experimental: No random assignment. Manipulated
IV, inferential statistics.
• Non-Experimental: No random assignment, no manipulated
IV. Inferential statistics. E.g. cohort, case-control, Cross-
Sectional (“correlational”), etc. Prospective/Retrospective.
• Descriptive: No random assignment, no manipulated IV, no
inferential statistics. May use descriptive stats such as %, means,
etc.
• Quantitative (as opposed to qualitative): Based on
standardized & relatively objective measures such as surveys, etc.
• Primary (as different from secondary or tertiary
research): Researcher does the actual “fieldwork” rather than
strictly review other existing research. However, primary
research always includes a secondary (review) section.
 Levels of Meta-Analyses
of RCTs Gold Standard in Secondary
Evidence (special stats)
(Review) Research
Syst. Reviews
Pyramid of RCTs
(verbal)
However, remember that Randomized-
quality matters! E.g. high Experimental Gold Standard in
Research (RCTs) Primary Research
quality non-experimental
research provides much Quasi-Experimental
Research (no randomized
stronger evidence than assignment)
shoddy randomized-
experimental Non-Experimental Research
(observational, no manipulation:
research. Cohort, Case-Control)
RCT = Rando-
Descriptive Research
mized
(no inferential stats, only descriptive
controlled stats: means, percentages)
Trial.
Tertiary Research
(opinion pieces, etc.)
 Research Terminology – Continued
Clinical Trial Phases
Clinical trials are conducted in a series of steps, called phases - each phase is designed to answer a
separate research question.

• Phase I: Researchers test a new drug or treatment in a small group of people for the first time to
evaluate its safety, determine a safe dosage range, and identify side effects.

• Phase II: The drug or treatment is given to a larger group of people to see if it is effective and to
further evaluate its safety.

• Phase III: The drug or treatment is given to large groups of people to confirm its effectiveness,
monitor side effects, compare it to commonly used treatments, and collect information that will allow
the drug or treatment to be used safely.

• Phase IV: Studies are done after the drug or treatment has been marketed to gather information on
the drug's effect in various populations and any side effects associated with long-term use.

• Additional Resource Information on clinical trials can be found

at http://clinicaltrials.gov/info/resources
 p-Value & Effect Sizes in Medical
Research
• Important indicator of a statistically significant difference
between groups based on the Null Hypothesis:
The p-value: p≤.05
• CIs (Conf. Intervals) are “inferential statistics.” Generally, in
comparisons of means, if CI crosses zero, then the observed
diff. is not statistically significant. In comparisons of Ratios &
Risks, if CI crosses one, then the observed diff. is not
statistically significant.
• Effect sizes (EF)– magnitude of the difference. Many
different kinds OR (Odds Ratio), RR, RRR (Relative Risk
Reduction), AR, ARR (Absolute Risk Reduction), NNT
(Number Needed to Treat), etc., depending on how computed
(each one has diff. formula). EXPLAIN the meaning of your
EF succinctly. I.e., explain if the magnitude of the difference is
small, medium or large.
 Do’s and Don’ts
• Do not use the word “prove.” In medicine, science, and social
science, we can only find or provide evidence (weak to strong),
but we are not able to “prove” anything beyond a doubt.
• Do not tell your colleagues what to do – that is not polite. Don’t
use “you.” Use third person or first person instead.
• Minimize reading from your PPT notes, so as to provide evidence of
a certain amount of knowledge. Make eye contact w/ audience.
• Provide a full citation when presenting your focus article. Include
name of author/s, title of article, journal name (in italics), date,
volume, page numbers. AMA format preferred, APA acceptable also.
Example:
McGinn T. Practice corner: using clinical prediction rules.
ACP Journal Club. 2002;137:A11-12.
• Discuss strengths and limitations of the focus article. It is OK if the
article has limitations/weaknesses – most research does. It is good
to show that you are aware of issues such as possible bias, uneven
treatment, confounding, potential threats to internal & external
validity, etc.
 Do’s and Don’ts Continued
• Spend approx. 20 min. on your team presentations.
• Do not spend more than approx. 5 min. on the intro.
• Try to pick focus articles about family medicine issues (e.g. do
not put too much emphasis on in-depth pharmaceutical
research or surgical research)
• It is perfectly OK to pick a focus article with “negative” results
(e.g. results showing “no difference,” etc.), bec. it is important
to minimize “Publication Bias.”
• Include one or more slides with your References.
• Critique # of participants only if
▫ The study did not detect statistically significant
differences (could not reject the Null Hypothesis), &
thus was perhaps not “powered” enough (e.g. did the
authors use Power Tables?).
▫ The small # of participants may affect external validity
(i.e. wide applicability)
PPT Grading Rubric
Gauge the Strength of the Evidence

Don’t Trust
Trust

Source: Consumer Reports on Health Vol. 24 No. 9 Sept. 2012 p. 6

 Confused?

Please Contact Sharon Tabachnick, PhD, MSLS (Dr. T.)

Education Coordinator
Department of Family Medicine
stabachn@uthsc.edu
Office: 901-448-7574
Mobile: 901-463-0261
Source of picture:
http://scienceblogs.com/thoughtfulanimal/2010/05/24/dog-personalities/