Alberto M. Marchevsky, MD, Cedars-Sinai Medical Center, Los Angeles, CA and Mark R. Wick, MD, 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 application 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 completed by interactive exercises 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, neural networks and simple Bayesian statistics for the development of patient-based rules for the application of immunostains in pathology practice, prognostic 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) introduction to the “FRAP” (framing questions, retrieve relevant data, appraise the quality and appropriateness of the data and patient-based decision making) paradigm, 4) 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), 5) introduction to the need to validate clinical rules with holdout data (“test sets”) not used for the derivation of the rules, 6) introduction to the development of EBCG for the utilization of immunostains in anatomic pathology.
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, and 2) 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. Registrants will receive a syllabus at the course and a CD of materials will be mailed after the course. (New Course)