Skip to main content

Advertisement

Log in

Guided Mentorship in Evidence-Based Medicine for Psychiatry: A Pilot Cohort Study Supporting a Promising Method of Real-Time Clinical Instruction

  • Original Article
  • Published:
Academic Psychiatry Aims and scope Submit manuscript

Abstract

Objective

Evidence-based medicine has been promoted to enhance clinical decision making and outcomes in psychiatry. Residency training programs do not routinely provide instruction in evidence-based medicine. Where instruction exists, it tends to occur in classroom settings divorced from the clinical decision-making process and is focused narrowly on appraisal of evidence quality. The goal of this pilot study was to develop and evaluate the promise of a method of “hands-on” instruction in evidence-based medicine done in real clinical time.

Methods

A modularized curriculum to promote decision-making strategies using evidence-based medicine during the course of actual patient care was delivered by an attending physician mentoringa small team on the inpatient and consultation-liaison psychiatry services at Stanford. A staggered cohort of 24 consecutive trainees was followed between August and January 2007. Measures of trainees’ skills in evidence-based medicine were assessed before and after mentoring. A blinded grader scored each inventory according to an explicit, predefined rubric. Demonstrated proficiency in delivery in each of the core skills of evidence-based medicine was assessed as a secondary outcome measure via the attending physician’s unblinded subjective evaluation of trainee performance. Subjective descriptions of the experience were obtained via review of trainees’ evaluations.

Results

Postmeasures of knowledge and skills in evidence-based medicine increased significantly relative to baseline. The Cohen’s d effect size was large and clinically meaningful. The majority of trainees were able to demonstrate adequate proficiency of skills by attending subjective evaluation. Trainees’ subjective experiences overall were positive.

Conclusion

Guided mentoring in evidence-based medicine appears promising for further study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sackett DL, Rosenberg WM, Gray JA, et al: Evidence-based medicine: what it is and what it isn’t. BMJ 1996; 312: 71–72

    Article  CAS  PubMed  Google Scholar 

  2. Straus SE, Richardson WS, Glasziou P: Evidence-Based Medicine: How To Practice and Teach EBM, 3rd ed. Edinburgh; New York, Elsevier/Churchill Livingstone, 2005

    Google Scholar 

  3. Drake RE, Rosenberg SD, Teague GB, et al: Fundamental principles of evidence-based medicine applied to mental health care. Psychiatr Clin North Am 2003; 26: 811–820, vii.

    Article  PubMed  Google Scholar 

  4. Drake RE, Torrey WC, McHugo GJ: Strategies for implementing evidence-based practices in routine mental health settings. Evid Based Ment Health 2003; 6: 6–7

    Article  PubMed  Google Scholar 

  5. Essock SM, Goldman HH, Van Tosh L, et al: Evidence-based practices: setting the context and responding to concerns. Psychiatr Clin North Am 2003; 26: 919–938, ix

    Article  PubMed  Google Scholar 

  6. Torrey WC, Drake RE, Dixon L, et al: Implementing evidence-based practices for persons with severe mental illnesses. Psychiatr Serv 2001; 52: 45–50

    Article  CAS  PubMed  Google Scholar 

  7. Gray GE: Concise Guide to Evidence-Based Psychiatry. Arlington, Va, American Psychiatric Publishing, 2004

    Google Scholar 

  8. Gray GE: Evidence-based medicine: an introduction for psychiatrists. J Psychiatr Pract 2002; 8: 5–13

    Article  PubMed  Google Scholar 

  9. Gray GE, Pinson LA: Evidence-based medicine and psychiatric practice. Psychiatr Q 2003; 74: 387–399

    Article  PubMed  Google Scholar 

  10. Hatcher S, Butler R, Oakley-Brown M: Evidence-Based Mental Health Care. Edinburgh, Elsevier Churchill Livingstone, 2005

    Google Scholar 

  11. March JS, Chrisman A, Breland-Noble A, et al: Using and teaching evidence-based medicine: the Duke University child and adolescent psychiatry model. Child Adolesc Psychiatr Clin N Am 2005; 14: 273–296, viii-ix

    Article  PubMed  Google Scholar 

  12. Dixon L: The need for implementing evidence-based practices. Psychiatr Serv 2004; 55: 1160–1161

    Article  PubMed  Google Scholar 

  13. Lehman AF, Steinwachs DM: Patterns of usual care for schizophrenia: initial results from the schizophrenia Patient Outcomes Research Team (PORT) client survey. Schizophr Bull 1998; 24: 11–20; discussion 20–32

    Article  CAS  PubMed  Google Scholar 

  14. Geddes J, Reynolds S, Streiner D, et al: Evidence-based practice in mental health. BMJ 1997; 315: 1483–1484

    Article  CAS  PubMed  Google Scholar 

  15. Deegan PE, Drake RE: Shared decision making and medication management in the recovery process. Psychiatr Serv 2006; 57: 1636–1639

    Article  PubMed  Google Scholar 

  16. Harris G: Psychiatrists Top List in Drug Maker Gifts. New York Times, June 27, 2007. Available at http://www.nytimes.com/2007/06/27/health/psychology/27doctors.html

  17. Wazana A: Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA 2000; 283: 373–380

    Article  CAS  PubMed  Google Scholar 

  18. Smith CA, Ganschow PS, Reilly BM, et al: Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability. J Gen Intern Med 2000; 15: 710–715

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Hatala R, Guyatt G: Evaluating the teaching of evidence-based medicine. JAMA 2002; 288: 1110–1112

    Article  PubMed  Google Scholar 

  20. Straus SE, Green ML, Bell DS, et al: Evaluating the teaching of evidence-based medicine: conceptual framework. BMJ 2004; 329: 1029–1032

    Article  PubMed  Google Scholar 

  21. Shaneyfelt T, Baum KD, Bell D, et al: Instruments for evaluating education in evidence-based practice: a systematic review. JAMA 2006; 296: 1116–1127

    Article  CAS  PubMed  Google Scholar 

  22. Green MLL: Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: a critical review of curricula. Acad Med 1999; 74: 686–694

    Article  CAS  PubMed  Google Scholar 

  23. Accreditation Council for Graduate Medical Education: ACGME Outcome Project: Instruction: Tips for Using Experience-Based, Integrative Evidence-Based Medicine (EBM). ACGME, Chicago, 2007

    Google Scholar 

  24. Miller WR, Rollnick S: Motivational interviewing: preparing people for change, 2nd ed. New York, Guilford, 2002

    Google Scholar 

  25. Knight KM, McGowan L, Dickens C, et al: A systematic review of motivational interviewing in physical health care settings. Br J Health Psychol 2006; 11: 319–332

    Article  CAS  PubMed  Google Scholar 

  26. Hettema J, Steele J, Miller WR: Motivational interviewing. Annu Rev Clin Psychol 2005; 1: 91–111

    Article  PubMed  Google Scholar 

  27. Burke BL, Arkowitz H, Menchola M: The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol 2003; 71: 843–861

    Article  PubMed  Google Scholar 

  28. Smith GCS, Pell JP: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials. BMJ 2003; 327: 1459–1461

    Article  PubMed  Google Scholar 

  29. Isaacs D, Fitzgerald D: Seven alternatives to evidence-based medicine. BMJ 1999; 319: 1618

    Article  CAS  PubMed  Google Scholar 

  30. Rollnick S, Mason P, Butler C: Health Behavior Change: A Guide for Practitioners. Edinburgh, Churchill Livingstone, 1999

    Google Scholar 

  31. Williams GC, Deci EL: The importance of supporting autonomy in medical education. Ann Intern Med 1998; 129: 303–308

    Article  CAS  PubMed  Google Scholar 

  32. Deci EL, Flaste R: Why We Do What We Do: Understanding Self-Motivation. New York, Penguin Books, 1995, p 149

    Google Scholar 

  33. Bandura A: Social Learning Theory. Englewood Cliffs, NJ, Prentice Hall, 1977

    Google Scholar 

  34. Bandura A: Self-Efficacy: The Exercise of Control. New York, WH Freeman, 1997

    Google Scholar 

  35. Kasser VG, Ryan RM: The relation of psychological needs for autonomy and relatedness to vitality, well-being, and mortality in a nursing home. J Appl Soc Psychol 1999; 29: 935–954

    Article  Google Scholar 

  36. Williams GC, Grow VM, Freedman ZR, et al: Motivational predictors of weight loss and weight-loss maintenance. J Pers Soc Psychol 1996; 70: 115–126

    Article  CAS  PubMed  Google Scholar 

  37. Williams GC, McGregor HA, Zeldman A, et al: Testing a self-determination theory process model for promoting glycemic control through diabetes self-management. Health Psychol 2004; 23: 58–66

    Article  PubMed  Google Scholar 

  38. Williams GC, Minicucci DS, Kouides RW, et al: Self-determination, smoking, diet and health. Health Educ Res 2002; 17: 512–521

    Article  PubMed  Google Scholar 

  39. Williams GC, Rodin GC, Ryan RM, et al: Autonomous regulation and adherence to long-term medical regimens in adult outpatients. Health Psychol 1998; 17: 269–276

    Article  CAS  PubMed  Google Scholar 

  40. Ainslie G: Breakdown of Will. Cambridge; New York, Cambridge University Press, 2001

    Book  Google Scholar 

  41. Gollwitzer PM: Implementation intentions: strong effects of simple plans. Am Psychol 1999; 54: 493–503

    Article  Google Scholar 

  42. Mascola A, Crane L, Simms R, et al: Encouraging physical activity among overweight patients as the main outcome of treatment: a pilot RCT of an adaptation of motivational interviewing, in Society of Behavioral Medicine, 27th Annual Meeting & Scientific Sessions. San Francisco, March 25, 2006

  43. Ramos KD, Schafer S, Tracz SM: Validation of the Fresno Test of competence in evidence-based medicine. BMJ 2003; 326: 319–321

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anthony Joseph Mascola M.D..

Additional information

Special thanks to Robert Drake, Matthew Merrens, Mary Turco, and Cindy Stewart from the Dartmouth Summer Institute in Evidence-Based Psychiatry for their ideas and feedback and their permission to use the Dartmouth Evidence-Based Psychiatry Inventory for this study. Thanks also to Marilyn Tinsley, our reference librarian, who generously donated her time and made our informatics rounds practical and enjoyable.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mascola, A.J. Guided Mentorship in Evidence-Based Medicine for Psychiatry: A Pilot Cohort Study Supporting a Promising Method of Real-Time Clinical Instruction. Acad Psychiatry 32, 475–483 (2008). https://doi.org/10.1176/appi.ap.32.6.475

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1176/appi.ap.32.6.475

Keywords

Navigation