UTHSCSA. Bridging Oral Health Science, Education & Practice: A CATs Initiative. ADEA 87 th Annual Session Washington DC March 3, 2010 JOHN D RUGH

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1 Bridging Oral Health Science, Education & Practice: A CATs Initiative NIH R25 DE18663 JOHN D RUGH UTHSCSA ADEA 87 th Annual Session Washington DC March 3, 2010

2 As Dental Educators & Scientists, What is our overarching Aim?

3 Ultimately To improve the oral health of the population.

4 Two Basic Strategies 1) Research to generate new knowledge 2) Transfer the new knowledge to new Dentists, Practicing Dentists and the Public

5 How are we doing? 1) Developing new Knowledge... A- 2) Transferring new Knowledge: To new Dental Students. B- To practicing Dentists..... D To the Public... D-

6 What s the Problem? UTHSCSA

7 Problem: Practitioners are not always Up-to-Date Nov 2009

8 Nov 2009

9 Transfer of Research into Practice Original Research Submission variable Acceptance Publication 0.5 year 0.6 year 0.3 year Bibliographic Databases Review, Paper, Textbook Implementation 6-13 years 9.3 years Years E.A. Balas, S.A.Boren. Managing Clinical Knowledge for Health Care Improvement. Yearbook of Medical Informatics 2000

10 Time in Practice and Quality of Care Choudhry, et al. Ann Intern Med, 2005 Systematic review of 62 studies. 94% of the 62 studies found decreasing competence for some tasks, with increasing physician age.

11 Time in Practice and Quality of Care. Conclusions: physicians who have been in practice for more years and older physicians possess less factual knowledge, are less likely to adhere to appropriate standards of care, and may also have poorer patient outcomes. Choudhry, et al. Ann Intern Med 142: , 2005

12 What s Going On? 1) Explosion of new knowledge 2) Half-life of current knowledge 3-8 years

13 Explosion of new knowledge Problem: There is just toooooo much to read!

14 We need new Educational models to fix this UTHSCSA

15 Knowledge BANK Professional Education: INFORMATION TECHNOLOGY MEMORIZE FACTS & THEORIES Read Everything Patient Care INFORMATION AS NEEDED Model Focus on problems your patients have..rather than trying to keep with everything.

16 Knowledge BANK Professional Education: INFORMATION TECHNOLOGY IT & PROBLEM SOLVING TOOLS Patient Care INFORMATION AS NEEDED Model

17 Proposed Solution Student & Faculty Preparation of Critically Appraised Topics (CATs) Teach Students skills of: 1. Asking focused clinical questions, 2. Quickly and efficiently finding the strongest evidence using a hierarchical search strategy, 3. Critical appraisal of the evidence and 4. Judgment regarding application of the evidence in the clinic. The aim is to promote lifelong learning skills UTHSCSA

18 Critically Appraised Topics (CATs) 2) Search 3) Appraise Clinical 1) Ask a Question 4) Write CAT Critically Appraised Topic (CAT) Encounter Student Faculty UTHSCSA

19 UTHSCSA CATs INITIATIVE* DSI EBD, Informatics Instruction 4hrs DSII EBD/CATs Instruction 16hrs CATs Requirement In Clinical Courses DSIII Case Conf CATs CATs Requirement in Clinical Courses & 8 GPGs DSIV CATs Requirement In Clinical Courses & 8 GPGs Residencies Res Meths 24hrs & CATs Instruction CATs Requirement in Clinical Courses Central Hypothesis: The CAT will serve as a mechanism to infuse science & critical thinking skills into dental education at all levels. UTHSCSA

20 FACULTY DEVELOPMENT EBP & CAT PREPARATION AND REVIEW TRAINING DS FACULTY.In-service RESIDENTS..Core Course ONLINE CATs DATABANK Selection Criteria Keyword Index Update Policy CAT REVIEW & EDITING ALUMNI.8hr CE course DSI EBD, Informatics Instruction 4hrs DSII EBD/CATs Instruction 16hrs CATs Requirement In Clinical Courses DSIII Case Conf CATs CATs Requirement in Clinical Courses & 8 GPGs DSIV CATs Requirement In Clinical Courses & 8 GPGs Residencies Res Meths & CATs Instruction CATs Requirement in Clinical Courses Student Research Programs NEW SCIENCE & ACADEMICIANS UTHSCSA

21 CATs Initiative DS2s FALL 2009 SPRING 2010 SUMMER 2010 INTD 6010 EBD/CATs Basics 16 hrs UTHSCSA Mini CAT Exercises 5 Clinical Courses 10-20min Full CAT INTD hrs Search OSCE INTD min FAST CATs ACAD Detailing 24 hrs COSTAR Research Program CTSA PBRN Clinical Research

22 CAT Examples

23 1) Formulating a focused (PICO) question: Diagnosis Clinical Question The KaVo website states: Example #1 DIAGNOdent aids in the detections of caries. Even very small lesions are detected at the earliest stage, enabling you to protect and preserve the tooth substance. Assignment: Formulate a PICO question to help you find the best evidence about the accuracy of DIAGNOdent in detecting early dental caries. your PICO question P: In dental patients I:.how effective is DIAGNOdent C: compared to the gold standard histology O: in the detection of proximal dental caries limited to enamel?

24 2) Selecting Appropriate Search Terms DIAGNOdent OSCE Clinical Question The KaVo website states: DIAGNOdent aids in the detections of caries. Even very small lesions are detected at the earliest stage, enabling you to protect and preserve the tooth substance. PICO Question In dental patients, how effective is DIAGNOdent compared to the gold standard histology in the detection of proximal dental caries limited to enamel? Skill Assessment Using PubMed, identify 3 appropriate terms to search for the strongest evidence related to the PICO question

25 3) Find the strongest evidence SYSTEMATIC REVIEW RANDOMIZED TRIAL COHORT STUDY CASE SERIES CASE STUDY 1967 TIME

26 Hierarchical Search Strategy PubMed Limits 1) Meta Analysis (under Type of Article ) 2) Systematic Review (under Subsets ) 3) RCT (under Clinical Queries RANDOMIZED TRIAL COHORT STUDY META-ANALYSIS Systematic Review of randomized clinical trials CASE SERIES CASE STUDY UTHSCSA

27 4) Assessment of the evidence Ranking of Journals - OSCE UTHSCSA

28 Assessing Strength of Evidence META-ANALYSIS Systematic Review RANDOMIZED TRIAL COHORT STUDY CASE SERIES CASE STUDY

29 CATs Initiative DS2s FALL 2009 SPRING 2010 SUMMER 2010 INTD 6010 EBD/CATs Basics 16 hrs UTHSCSA Mini CAT Exercises 5 Clinical Courses 10-20min Full CAT INTD hrs Search OSCE INTD min FAST CATs ACAD Detailing 24 hrs COSTAR Research Program CTSA PBRN Clinical Research

30 60 Faculty CAT Mentors Students and Faculty Co-Author the CATs Two Students per Faculty

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36 LIST of CAT 76 CATs to Date

37 Done This Year:

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39 Printer Friendly Version One Page

40 CATs Initiative DS2s FALL 2008 SPRING 2009 SUMMER 2009 INTD 6010 EBD/CATs Basics 16 hrs UTHSCSA Mini CAT Exercises 8 Clinical Courses 10-20min Full CAT INTD hrs CAT Debate RESD 6002/PCL 2hrs Search OSCE INTD min FAST CATs ACAD Detailing 24 hrs COSTAR Research Program CTSA PBRN Clinical Research

41 ONLINE CATs DATABANK Selection Criteria Keyword Index Update Policy SCIENCE TRANSFER FACULTY, STUDENTS, PRACTITIONERS & PUBLIC STUDENT N=39 CATs Faculty Visit 5 Dental Alumni offices and to discuss and receive feedback on CAT. CAT Program FACULTY, ALUMNI, STUDENT TEAM Alumni Hr CE Credit! + DS Credit

42 Data Collection Plan Group Spring/Summer 2008 Year Year Year Year Cohort DS1 Year (Spring 2008) Student Course Evaluations Focus Group (May 2008) OSCE (Test run) DS2 Year (Spring 2009) Focus Group DS3 Year (Spring 2010) Focus Group DS4 Year Cohort (Current DS2s) (September 2008) Baseline KACE at beginning of DS2 CATS course (January 2009) KACE Post-test Student Course Evaluations (March 2009) Focus Group (May 2009) OSCE DS2s Year (Spring 2010) Fresno Test of EBP Competence Focus Group DS3 Year (Fall 2010) KACE (Spring 2011) Fresno Test of EBP Competence Focus Group DS4 Year Cohort (New DS1s matriculating in (July 2008) KACE Reliability testing (October 2008) Pre and Post-test reliability DS1 Year (September 2009) KACE at beginning of DS-II CATS course (November 2009) KACE at end of CATS course (January 2010) Focus Group (May 2010) OSCE DS2 Year (Spring 2011) Fresno Test of EBP Competence Focus Group DS3 Year (Fall 2011) KACE (Spring 2012) Fresno Test of EBP Competence Focus Group DS4 Year

43 Aim #2: Faculty Development. Provided 26 hours of faculty development resulting in 842 faculty contact hours. 73% of the school s course directors have received instruction on EBP UTHSCSA

44 Aim #5: Disseminate Findings Invited Presentations Dealing with CATs Program..16 Research Abstracts & Posters Presented (2009) 12 Abstracts Submitted for 2010 AADR Meeting (Washington, D.C.).. 9 Abstracts for IADR Spain.2 15 of 23 Abstracts are student research projects!

45 FACULTY DEVELOPMENT EBP & CAT PREPARATION AND REVIEW TRAINING DS FACULTY.In-service RESIDENTS..Core Course ALUMNI.8hr CE course CATs ONLINE Selection Criteria Keyword Index Update Policy WEB BASED CAT REVIEW PANELS FEB 2010 DSI EBD, Informatics Instruction 4hrs DSII EBD/CATs Instruction 16hrs CATs Requirement In Clinical Courses DSIII Case Conf CATs CATs Requirement in Clinical Courses & 8 GPGs DSIV CATs Requirement In Clinical Courses & 8 GPGs Residencies Res Meths & CATs Instruction CATs Requirement in Clinical Courses = DONE = To Do Student Research NEW SCIENCE & ACADEMICIANS R25 Central Hypothesis: The CAT will serve as a mechanism to infuse science & critical thinking skills into dental education at all levels and provide a recruitment tool for new scientists.

46 NIH/NIDCR John Hatch Tom Deahl Mabel Hernandez Pattie Nield Bill Hendricson Erhan Kartaltepe Birgit Glass Gary Guest Ken Kalkwarf Thank you! Naomi Sever Elizabeth Wallmann Jim Summitt Kevin Gureckis Bjorn Steffensen Linda Levy Debra Stark Rita Parma Bill Rose Steve Matteson +60 CATs Faculty Mentors

47 QUESTIONS? COMMENTS? CONCERNS? OTHER OPTIONS? UTHSCSA

48 Discussion UTHSCSA

49 Implementation Challenges Teaching CATs UTHSCSA Faculty Time/Priorities Technology Library Online Limits (Ovid vs. PubMed) Quality of CATs Student writing skills Controversial CATs (3 rd molar extraction) Control of Plagiarism Focus on science User rather than Doer