Evidence Based Practice

In 2018 I led the educational redesign of our evidence based practice (EBP) workshops. The redesigned workshops were implemented in 2019.

Previously the workshop involved 9 hours face-to-face teaching delivered as a mixture of short didactic lectures and small group work. Examples were exemplars but generic and same examples were used irrespective of clinical areas attending the workshops and materials were provided in the form of printed workbooks. Participants were from various departments, with 10-20 participants at each workshop. We often had more participants register than turn up, meaning that we were also generating considerable waste from left over printed materials. While we had good engagement from Allied Health and modest engagement from nursing, we had almost no engagement from the medial group. Given that there are > 9,000 hospital employees, it became clear that to achieve overall better engagement with Evidence-Based Practice and subsequent positive patient impact, a different approach was required.

During the redesign, I spoke with several departments, both those that had engaged with us previously and those who had not, and to identify how the workshops could be tailored to meet their needs. I also explored whether engaging whole of departments was of interest, and how it would be feasible. It became clear that most departments already had set education time for clinicians, usually in 1 to 4-hour blocks so longer blocks were unlikely to fit majority of health service schedules.

While participant feedback (both informally and through feedback forms) indicated that participants valued the workshops and often referred to the workshop materials during practice, they also felt that there was a lot of content to cover, and that the examples used were “not really relevant to their area”.

Parallel to this, Bond University’s Master of Healthcare Innovations was under development, and planned to use the old 9-hour EBP workshop as the basis of their first 6 weeks of teaching in the Evidence Based Practice and Policy unit and it was envisioned that those who had completed our Gold Coast Health EBP Workshops could be micro-credentialed for the first half of this unit.

When considering the redesign, I had to develop an approach that was flexible enough to suit individual department needs, and could be delivered as a single session or as several sessions, and needed to provide opportunity for self-directed learning before or after the workshops so that learners could consolidate their knowledge. To address waste generated from un-used printed materials and modernize the approach, use of technology rather than printed material seemed the obvious option – however, I also had to ensure that technologies used could be access by clinical staff not enrolled formally through Bond University. I also wanted to develop materials that could be used in practice to reinforce EBP practice and support ongoing engagement ensuring that participants had access to key concepts that may not have been covered during the now shortened face-to-face time.

The redesign involved developing a mixed approach including conversion of the didactic teaching and small group work into interactive online eBooks (developed in Articulate) accompanied by 4-hour face-to-face workshops and can be delivered in a 4 hour, 2x2 hour, or 4 x 1 hour formats. The eBook takes a deep dive on the topic area, with additional links, videos, worked examples, and summative quizzes with feedback. Participants are asked to complete module 1 (Formulating an Answerable Question) as preparation work before coming to the session. All modules that were developed have been used as the basis of the Evidence Based Practice and Policy unit.

The workshops themselves are tailored, engaging clinical departments in the selection of topic areas and articles to be used during the workshop. The workshop uses short lectures followed small group work facilitated by a tutor. In 2022 we added the use of anonymous in-class polling using (Poll Everywhere) to increase engagement, and consolidate knowledge to ensure key concepts have been understood. The group work uses departmentally relevant examples to exemplify EBP concepts, thereby provide immediate relevance to learners not only with respect to the EBP concepts, but also clinically.

One unanticipated and positive outcome of this approach has been that clinicians feel far safer discussing difficult concepts such as EBP when they are able to contribute regarding the clinical relevant and impact of the examples discussed; anecdotally, the participants are far more engaged now during the sessions than they were using the old format.

Workshop materials, short summaries, and eBook links are embedded in a Professional EBP e-Portfolio, delivered as a single package. The portfolio also contains suggestions for ongoing engagement and further development of EBP skills. The portfolio was originally developed using Microsoft Office OneNote which is readily accessible by GCH staff and can be accessed via mobile; however, due to compatibility issues with Macs and recent updates with Microsoft 365, this has since been replaced with pdf and word versions, with more holistic options under investigation.

Small group facilitators are also provided with opportunities for professional development through an intensive 2-hour training session prior to the workshop delivery. The session is attended by all facilitators. During the session we discuss the research methods used by the selected articles, and how best to use them to teach key concepts. As the sessions are attended by senior epidemiologists, statisticians as well as mid and earlier career health researchers, there are significant opportunities to learn and develop both research and teaching skills. As of 2020 tutors now include department clinical staff who have attended previous workshops and wish to develop their EBP skills further and become local experts.

Previously we had little success in engaging medical staff in the workshops, with most attendees from Allied Health and some from Nursing. The new model has been highly successful in engaging interdisciplinary staff, including medical staff, from several clinical areas. In 2019 I led workshops delivered to Emergency, Intensive Care, Oral Health, Allied Health, and Mental Health departments, training over 300 clinical, research, and support staff. This trend has continued since and we have now trained over 400 despite the pandemic putting many teaching activities on hold. The ED, ICU, Anaesthetics, and Trauma departments have asked for a joint session given their clinical overlap and see the workshops as an opportunity to be on the same page regarding key clinical concepts as well as approach to evidence use in practice. They, along with several other departments, have requested that the EBP workshop be part of their regular mandatory education for clinicians.

Module example (Formulating an Answerable Question) available here: https://rise.articulate.com/share/dXG6wVXjgvMnNuqXwf1bJk0fho5oupGR

EBP WORKSHOPS DURING A PANDEMIC – ONLINE APPROACH

As a result of the COVID19 pandemic we adjusted our teaching approach to allow for online attendance using Zoom. Zoom allows for break out rooms, which will simulate the “tables” for small group work. More importantly, unlike TEAMS, Zoom allows people to phone in if their computer does not have a proper microphone or audio set up and can be accessed by clinical staff without having to be enrolled at Bond University ensuring accessibility for all participants.

DETAILED PARTICIPANT FEEDBACK ON EBP WORKSHOPS

Cumulative feedback since 2019 indicates that the redesigned workshop has been consistently highly rated by participants. Average workshop rating is 3.5/4.

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"Thanks for delivering an enjoyable, instructive and very interactive critical appraisal workshop. The facilitators were also wonderful per verbal feedack I've recieved." Workshop participant - Medical Education Registrar, Mental Health and Specialist Services GCH

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"I would like to thank you for the opportunity last year to participate in the EBP workshops that you organised and conducted with the Emergency Department last year, and strongly support your Early Career Teaching award nomination at Bond University.

I have been a practicing Emergency Department consultant in this hospital since 1997. Evidence based practice was not taught to me at medical school as a student, and my exposure to this method of critical appraisal has been haphazard and mainly self directed.

Your program was excellent and very well received by the senior ED clinicians who participated. It did not assume knowledge, but was pitched at the appropriate level for the audience involved. Your teaching style was very engaging and kept the interest of the audience on a topic that many of us struggle with.

Clinically I have found this very useful for me to incorporate into my clinical practice in helping me make decisions about appropriate patient care. It also helps me better supervise the junior doctors and medical students that I have contact with, who are taught to think in this manner from an early age.

I would also support you continuing this program across all clinical areas as I think these concepts need regular reinforcement to embed them into practice." Workshop participant - Deputy Director, Trauma Service, GCH.

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"I would like to acknowledge Paulina Stehlik efforts in redesigning and coordinating the Evidence

Based Medicine workshops and courses for clinicians and staff at Gold Coast Hospital.

These workshops have been designed specifically for clinicians and empower them to be able to read and use research in their everyday practice. Each workshop consists of interactive lectures that

introduce key research concepts and is followed by small group activities and discussion. I have assisted in facilitating two workshops both of which attendees spoke very highly about the quality of the workshop and its relevance and applicability to practice.

As a facilitator, it is evident the amount of work and effort that Paulina Stehlik puts into designing and delivery of each of these workshops. For example, each workshop is tailored to meet the needs and clinical interests of participants who are scheduled to attend the workshop e.g. staff from Emergency or allied health departments. Prior to each workshop, facilitators are provided with the required resources and these are then revised in a group format. 

This process is a valuable learning opportunity for facilitators and ensures that everyone is comfortable and confident with the content

for the upcoming workshop and able generate small group discussion. The success of the Evidence Based workshops to date is a complete reflection of Paulina’s passion for teaching Evidence Based Medicine, her dedication, degree of preparedness and ability to coordinate facilitators (at all stages of their career) to ensure a productive and enjoyable learning experience for all involved." Workshop facilitator - Post-Doctoral Research Fellow, Institute of Evidence-Based Healthcare, Faulty of Health Sciences and Medicine