This page outlines the information needed to prepare and present your Pediatric EBM Club talk. The handouts are also available for download from the site (Word). 

These materials have been adapted from the JAMA text: Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice. UM residents and faculty can access the text online at http://www.usersguides.org - use the passwords at the following link.

• Goals for Pediatric Journal Club
• Process of EBM
• Where Questions Arise From in Clinical Practice
• Making Your Presentation
• Overheads for Download
• Preparing Your Critically-Appraised Topic

1. Apply EBM skills as part of lifelong learning in order to improve the care of patients on the wards and clinics 
2. Be able to develop a well-built (PICO) question from a clinical scenario 
3. Understand key search terms and use them to identify relevant literature
4. Critically appraise an article in the style outlined by Sackett et al. 
5. Apply the results of the EBM process to the care of a patient 
6. Present journal club in an educational fashion, giving equal emphasis to both the clinical content and the EBM process 
7. Contribute a well-done Critically-Appraised Topic (CAT) to the pediatric EBM website 
8. Utilize the Peds EBM website and its links to enhance patient care 
9. Highlight one aspect of your literature search during the presentation.

Be sure to contact your mentor several weeks in advance. S/he will be able to help you with the EBM process and will review your presentation and Critically-Appraised Topic (CAT).

1. Start with your patient. Pick your question first!  Don't just find any old article.  The book talks about how to develop your question. Use the PICO format.
2. Search for the best available literature. Use your mentor or one of the medical librarians to help you identify the best search terms. Limit to clinical trials for therapy articles, use Sensitivity and Specificity for diagnosis articles, and exp cohort studies for prognosis articles.
3. Critically appraise your article(s). Use the book. It has a few useful pages about how to interpret different article types.  You should EXPLICITLY go through these during your talk.  This is what you are teaching your colleagues - not stats, not details about how many patients are in the study, etc. Again, your mentor should be useful here.
4. Describe how you will apply this information back to your patient. Be sure to follow the outline below for your presentation. 

1. Clinical findings:  how to gather and interpret findings from the history and physical exam
2. Etiology:  how to identify causes for disease
3. Differential diagnosis:   when considering the possible causes of a patient’s clinical problem, how to rank them by likelihood, seriousness, and treatability
4. Diagnostic tests:  how to select and interpret diagnostic tests, in order to confirm or exclude a diagnosis, based on considering their precision, accuracy, acceptability, expense, safety, etc.
5. Prognosis:  how to estimate the patient’s likely clinical course over time and anticipate likely complications of the disease
6. Therapy:  how to select treatments to offer patients that offer more good than harm and are worth the efforts and costs of using them
7. Prevention:  how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening
8. Self-improvement:  how to keep up to date; improve your clinical skills; and run a better, more efficient clinical practice

1. The clinical question.  How it was formed.  Explain the thought process. (5 min)
2. HOW you found what you found. (2 min)
3. WHAT you found. (3 min)
4. The VALIDITY & APPLICABILITY of what you found. (7 min)
5. How what you found will ALTER your MANAGEMENT of the patient. (8 min)
6. Self-assessment of  how you did with the process. (1 min)

• CAT Outline
• Overview of Article Selected
• Therapy Questions
  
• Diagnosis Questions

Critically-Appraised Topic (CAT) Guidelines

1. Title - -should be in the form of a declarative sentence giving the bottom line.
2. Question - give brief summary of clinical scenario and question in PICO format.
3. Bottom line - give the 2-3 summary points that come from your article(s). Include the NNT or LR. Can reference your article in this section if desired.
4. Summary of key evidence - 3-8 summary points from the article(s). The first reference should be your main article. Include such key information as the types of patients included in the study, the inclusion/exclusion criteria (if relevant to describing the population), the key methods (like drug doses, how the diagnostic test was done, etc.), the main results. You should also have 1-2 sentences that summarize the validity of the article(s).
5. Additional information - this is the place to summarize other studies, physiologic mechanisms, other consensus statements (AAP Policies, etc.)
6. References - These should be only the studies that you cite in the above sections. Don't include references that you looked at but didn't cite in the text of the CAT. You do not need to cite the EBM book. Your main article should be the first reference. All references should follow the following format: Lantz P, Pollack HA. Tobacco use in adolescents: Back to the future. Arch Pediatr Adol Med 1999; 253: 1099-1105. 
7. For a template, click here.