Know Thy Limitations

Recently I tried something new for our resident journal club. I am using Edmodo ( to post the readings and the protocol (boring) and to stimulate learning by posting “Homework Questions” that require learners to digest the background information and relay how they might use it (exciting). One resident had a great insight that many of us dont think about—- the limitations of our tools. She pointed out that a clinical prediction rule she uses (the CHADS2 score for afib) wasnt as good as she thought.

For some reason, as doctors, we assume tests are really good….prediction rules are accurate…..treatments always help. These tools are better than nothing (some of the time) but they arent perfect. This resident pointed that out in an insightful way. Bravo to her. I challenged our journal club group to look at things they use regularly and review their development. Know their limiations.

I see rules used improperly all the time (for example reporting a TIMI score for a patient with nonanginal chest pain) and when I call the resident or student out for using it improperly I usually get a blank stare. They dont realize the tool cant be used in that situation.  They are using tools in ways they werent developed for. Who knows if they work or not in this application.  We as educators, especially as EBM educators, need to challenge ourselves and our learners to get know (how they were developed and validated) the tools we rely on and know their limitations.

And so it begins….

I have been thinking about blogging for some time but never took the plunge. Well I just plunged.

This blog will be devoted to interesting bits about the limitations of evidence, how to use evidence in the care of patients, an occasional summary of the evidence itself, and about teaching EBM.

I am embarking on an interesting journey to develop an online course on evidence based medicine for UAB medical students. I previously taught a standard lecture course on EBM but when the curriculum changed my course became a “theme” and thus was mostly dropped from the curriculum (despite it being a theme of the curriculum– go figure!). “Surprisingly” the students’ step 1 scores on EBM type material plummeted. Who would have thought that if they didn’t learn the material they wouldn’t score well on a test? I recently received a fairly large grant to develop an online course to guide the students in learning how to be an EBM practitioner.

This has been an amazing experience so far. I have learned a lot about teaching and learning (though I have been a medical educator for over a decade I keep realizing I don’t know as much as I thought about teaching), curriculum design, and the future I think (and hope) of medical education. I hope my course can become a demonstration project for UAB so that more courses will develop online components and get away from the silly idea of lecturing at medical students and making them learn at our (the teachers) pace and not their own.