WHY AREN'T PHYSICIANS' PRACTICES EVIDENCE-BASED?

Course size limit: none Level: Intermediate Background: Evidence-based medicine (EBM) integrates the best scientific evidence with clinical expertise and patient values. However, physicians often fail to practice in accord with EBM principles and many attempts to change physician behavior to make it more evidence based have failed. Objectives and Course Description: This course will examine reasons physician practice at times fails to adhere with EBM principles and explore promising interventions to improve EBM-based practice. The impact of human thinking strategies designed to cope with inherent cognitive limitations that may lead to judgments and decisions that fail to conform with normative ideals (with emphasis on judgment and decision biases and heuristics) will be discussed for each stage of the evidence-based decision making process: identifying options and their outcomes; assessing probability of outcomes; assessing value of options; and combining information to make a decision. The course will examine the impact of organizations and culture on medical decision making and practice, which increasingly is provided from within large organizations whose leadership, structures, processes, incentives and environments (e.g., time and economic pressure; conflicts-of-interest) may undermine EBM-based care. The growing presence and impact of stealth marketing, special politically correct pleadings, suppression and manipulation of research, perverse bureaucratic and financial incentives, and intimidation and coercion that may challenge and undermine elements of an EBM approach will be identified, described and discussed. The course will conclude with review and exploration of promising approaches based on findings in the cognitive psychology to address physicians' human cognitive limitations that may help physicians practice more in accord with EBM, as well as general approaches to defend evidence-based decision practice from health care environment threats.

• Understand principles and impact of human cognitive behavior used to cope with cognitive limitations at each stage of the clinical decision making process.
• Understand organizational challenges to EBM practice.
• Understand environmental and social/cultural threats to increasing EBM practice.
• Understand promising approaches for facilitating physician EBM practice.

Format, Requirements, Target Audience: Didactic review of the cognitive psychology and organizational theory literature and interactive critical review and discussion of case studies and interventions to improve evidence-based practice.