Evidence-based decision-making as a practice-based learning skill: a pilot study

Area of Science:

• Medical Education
• Psychiatry
• Health Services Research

Background:

• Physicians face a growing need to balance standardized care with individualized patient needs.
• Practice-based learning and improvement (PBL) programs can bridge this gap by enhancing competency in using treatment guidelines and patient-specific information.
• This study aligns with the Accreditation Council for Graduate Medical Education's (ACGME) competency-based approach.

Purpose of the Study:

• To describe and evaluate a PBL program designed for physicians in training.
• To assess the program's effectiveness in developing skills for incorporating patient-specific factors into treatment recommendations.
• To test a program consistent with a multilevel, competency-based educational framework.

Main Methods:

• A pilot program was conducted with 22 psychiatric residents and fellows.
• Participants reviewed a schizophrenia treatment guideline and case vignettes of varying complexity.
• Assessments focused on how clinical and patient-specific factors influenced treatment recommendations.

Main Results:

• Most participants found treatment guidelines helpful for decision-making.
• Treatment recommendations were influenced by guideline criteria, clinical features, and patient perceptions.
• Incongruence between clinical data and patient experience significantly impacted recommendations.

Conclusions:

• Integrating patient experience with clinical knowledge improves the use of treatment guidelines.
• The PBL program aids in preparing clinicians to manage the dual demands of standardization and adaptation in practice.
• The program is adaptable for various disorders and clinical/patient complexities.