Assessing the degree of evidence based therapeutic intervention in a university based family medicine outpatient clinic

BACKGROUND: Despite the development of medical knowledge and technology, it has long been pointed out that the treatment guidelines are not sufficiently based on evidence. It has not been yet studied how evidence based medicine is implemented when physicians make their therapeutic decision. The purpose of this study was to determine the degree of evidence based interventions in a university based family medicine outpatient clinic. METHODS: The degree of evidence based practice was evaluated using Ellis and Gills' method developed by the Evidence - Based Medicine Center in Oxford. The Patients' records of an outpatient clinic of a university hospital were reviewed on the primary diagnosis - intervention. The evidence based guidelines were defined as traditional textbooks and the results of randomized controlled trials found on databases such as Medicine, Clinical evidence, Best evidence, and Cochrane. ln case where there were no guidelines, consultation with the specialists was done. The degree of the evidence based therapeutic interventions was assessed by three levels. RESULTS: There were 179 primary diagnosis - intervention pairs, among them, 125 pairs (69.8%) of interventions were based on randomized controlled trial evidence and 19 pairs (10.6%) based on convincing non-experimental evidence. No evidence was found for 35 pairs (19.6%) . As a result, 80.4% of the total 144 pairs were regarded as evidence - based medicine. CONCLUSIONS: The result showed that considerable portion of the total cases were evaluated as based on clinical evidence, which is similar to the conclusions of the previous studies in other countries. We hope that future similar studies will be conducted in other institutions as well as in other specialities.

An Experience of OSCE for Introducing Clinical Performance Assessment to Korean Medical Licensure Examination / 한국의학교육

BACKGROUND: Evaluation of clinical performance is an essential area of Medical Licensure Examination. Yet, clinical skills has been neither uniformly well taught nor adequately assessed. This study was done as a part of preliminary study to introduce clinical performance assessment to Korean Medical Licensure Examination. The goals of this study were to identify the potential logistic problems and to examine the feasibility of OSCE to Medical Licensure Examination. METHODS: 48 minutes long OSCE, which consist of eight 5-minute stations, was developed. The same examination was administered to students over a four-week period. RESULTS: Total 26 volunteer fourth-year medical students were tested. 11 students were examined at the first administration and the rest of them were evaluated four-week later. Cronbach alpha of the total stations was 0.52. Any big administration problems were not revealed. There was no significant total score difference between early examinee and later ones. Students evaluated the OSCE contents and process positively. CONCLUSION: To acquire more reliable and valid examination, we need to develop more objective checklist and evaluator and SP training.