2013 Articles

The Roadmap: a blueprint for evidence literacy within a Scientifically Informed Medical Practice and Learning Model

Silva, Suzana Alves; Wyer, Peter C.

Background: A model of clinical practice that encompasses clinical relationships and choices as well as the use of clinical research has yet to be elaborated. We sought a model for Scientifically Informed Medical Practice and Learning (SIMPLE) through integrating concepts borrowed from narrative medicine with the results of a competency-based assessment project.

Methods: The SIMPLE model started by subordinating the cognitive skills within an information literacy model (‘ask’, ‘acquire’, ‘appraise’ and ‘apply’) to the content of clinical actions (‘therapy’, ‘diagnosis’, ‘prognosis’ and ‘harm’). This enabled a description of problem delineation. The content of these components was developed through an iterative, reflexive approach, elaborating distinctions across all action domains. This led to the “Road Map” component of the model. Clinical action domains were defined within a relational construct.

Results: We defined 3 sub-categories of Problem (utility, performance and likelihood) leading to shared Actions, Choices and Targets (PACT) within the SIMPLE model as a bridge between relational and information literacy fields. The enabling skill ‘ask’ and the “Patients, Interventions, Comparisons, Outcomes” (PICO) format, was applied uniformly across these categories. ‘Acquire’ was elaborated using a 3-S format (Summaries, Syntheses, Single studies) that links study designs to electronic sources (published synopses, filtered databases and large bibliographical databases). ‘Appraise’ involved evaluation of design-specific susceptibility to error and of importance of the results classified as measures of frequency, effect, impact and precision. Finally, ‘apply’ included assessment of directness of evidence, contextual issues and overall benefits versus risks. Translation of knowledge into action involved constructed priorities and preferences within the relational field.

Conclusion: The Road Map enables linkage of a broad range of patient and practitioner concerns related to clinical action to a comparably broad spectrum of contemporary clinical research. It may usefully guide curricular and instructional approaches. Empirical validation in improving learning outcomes is required.