Teaching Our Residents How to Evaluate Outcomes
Hrair Mesrobian, MD, MSc, Professor, Pediatric Urology
Our students and residents are constantly bombarded with medical information from diverse sources. Of the hundreds of articles published daily in the urologic literature, only a fraction are based on sound research methodology and are able to be generalized to positively influence outcomes. The teacher’s challenge is to show the student of urology how best to sift through the literature and select the best diagnostic test, treatment modality or procedure which, when applied in the context of the clinical scenario, yields the most desirable outcome. It is extremely rewarding to teach methodology which may be applicable throughout a career, as learning does not stop with the completion of residency. In fact, new knowledge supersedes (or even contradicts) the old very rapidly.
This process is one of systematically finding, appraising and using the strongest contemporaneous research information as the basis for clinical decision-making aimed at achieving the best outcomes. The venue can be the operating room, clinics, the emergency room or during small group discussions to approximate real practice scenarios. These scenarios have been shown to stimulate exploration of issues from a range of disciplines, as well as to synthesize new learning. The teacher’s role includes assisting trainees in problem analysis, stimulating critical thinking and most importantly, in hypothesis formulation. The latter will strongly influence the sequence of clinical data obtained. We have a funded protocol designed to develop a curriculum to educate our residents and medical students in this critical analysis.
More specifically, we anticipate residents and students will learn to:
Formulate the management question to be answered
Find applicable answers
Select the appropriate diagnostic test
Interpret the resulting information and appraise its validity and relevance
Choose among several treatment options
Incorporate the evidence with the unique circumstances of patients, including their preferences
Outcomes analysis is an every day activity for the active physician. Initiatives such as this will help foster lifelong learning and understanding for our future caregivers.