Alberto M. Marchevsky, M.D., Cedars- Sinai Medical Center, Los Angeles, CA and Mark R. Wick, M.D., Virginia Health System, Charlottesville, VA
Evidence-Based Medicine (EBM) and Medical Decision Analysis (MDA) are relatively new disciplines that use quantitative methods to assess the value of "information" and integrate "best evidence" into cost-effective patient care interventions. Although these disciplines are already being integrated into the curricula of most Medical Schools and have resulted in the development of a large number of scientific publications and clinical guidelines they have stimulated little interest in Pathology. This course is designed to introduce pathologists, residents and fellows with the basic concepts of EBM and MDA, and suggest various potential applications of the methods being proposed by these disciplines for the analysis of problems in Pathology practice and research.
The course will be organized as a series of lectures that will briefly discuss the basic principles of EBM and MDA illustrated by practical examples designed to review the "quality" of recent publications in the pathology literature according to EBM principles and help the participants learn to apply software tools of meta-analysis, and simple Bayesian statistics for the development of evidence- based rules for the application of immunostains, identification of evidence- based diagnostic criteria, integration of prognostic and predictive models and other applications.
Specific topics to be discussed include: 1) an epistemological review of the current state of the art in current pathology practice with a discussion of the differences between a "disease", "clinico-pathologic syndrome" and "pathologic entities", precision of current diagnostic and prognostic models in anatomic pathology and other considerations, 2) brief review of the history and basic concepts of EBM and an overview of how to critically assess the quality of published literature, 3) review of different systems to evaluate levels of evidence, 4) introduction to the "FRAP" (framing questions, retrieve relevant data, appraise the quality and appropriateness of the data and patient -based decision making) paradigm, 5) introduction to MDA and the use of Bayesian statistical methods, meta- analysis, decision trees and other tools for the development of patient -based evidence-based guidelines (EBCG), 6) introduction to the need to validate clinical rules with holdout data ("test sets") not used for the derivation of the rules, 7) introduction to the development of EBCG for the utilization of immunostains in anatomic pathology, selection of most valuable diagnostic features in difficult differential diagnoses, evaluation of prognostic features with meta-analysis and other applications.
After completion of the course, participants will be able to 1) acquire a better understanding of the validity and applicability of data being published in the literature, 2) appreciate the value of approaching various problems in pathology using a systematic approach that takes into consideration evidence levels and study design limitations and 3) become aware of the availability of a variety of quantitative methods that are being widely used in other medical specialties yet have not been generally applied for the analysis of data in pathology research and practice.
A syllabus will be distributed to registrants at the meeting. After the meeting, all participants will receive web access to the PowerPoint presentation given at the Annual Meeting along with the text portion of the syllabus.
(LAST SCHEDULED PRESENTATION) This course may be used for CME credits or SAM credits.