646 October 2002 Family Medicine Inn ovati ons in F amily Medi cin e Edu ca ti on Joshua Freeman, MD Feature Editor Editor’s Note: Send submissions to jfreeman3@kumc.edu. Articles should be between 500–1,000 words and clearly and concisely present the goal of the program, the design of the intervention and evaluation plan, the description of the program as implemented, results of evaluation, and conclusion. Each submis- sion should be accompanied by a 100-word abstract. You can also contact me at Department of Family Medicine, University of Kansas, Room 1130A Delp, 3901 Rainbow Boulevard, Kansas City, KS 61160-7370. 913-588-1944. Fax: 913-588-1910. Though many residencies recognize the need for instruction in evidence- based medicine (EBM), the best way to teach these skills to residents remains uncertain. Traditional cur- ricula, such as journal clubs and lec- tures, have been criticized for their lack of immediate applicability to clinical practice. A recent system- atic review of instruction in critical appraisal skills using these types of curricula demonstrated that resi- dents have smaller gains in knowl- edge when compared with medical students. 1 Because we felt that if residents had a clinical stake in what they were learning and producing, it would lead to increased absorp- tion and retention of both knowl- edge and skills, we chose to teach EBM skills by producing a local, residency-developed clinical prac- tice guideline on a common medi- cal problem. Methods All 11 residents and three faculty members participated in the guide- line development process. The site was a rural family practice resi- dency training program. The pro- cess was conducted over a 6-month period and consisted of monthly meetings, with independent work required between the sessions. The residents had received a set of lec- tures on the basics of critical ap- praisal earlier in the academic year. We first solicited support for the idea of a guideline development project from the learners. The group then chose type 2 diabetes mellitus as the broad topic for the guideline, given its prevalence among the pa- tients in our family practice center and the residents’ stated need for some guidance in the care of these patients. The participants were each asked to develop a clinical question T eac hing Ev idence- bas ed Me dicine Sk ills Thr ough a Res idenc y -de v e lope d Guideline John Eplin g, MD; John S mu cny, MD; Anit a P atil, MD; Fred T u div er, MD From the Department of Family Medicine, SUNY-Upstate Medical University (Drs Epling and Smucny); private practice, Jersey City, NJ (Dr Patil); and Department of Family Medicine, East Tennessee State University (Dr Tudiver). Though many residencies have recognized the need for instruction in evidence-based medicine, the best way to teach these skills to resident physicians remains uncertain. We designed a curriculum intended to develop a resident-produced, evidence-based guideline for the care of patients with diabetes. Each resident was supervised going through the steps of evidence-based medicine: asking a clinical question, searching for the evidence to answer that question, appraising that evidence, and producing an evidence-based answer. These answers were then compiled into a guideline distributed in the residency practice. An evaluation of this curriculum using focus group and survey data showed that learners appreciated the skills and knowledge gained in devising guidelines in an evidence-based manner but were uncertain that their searches were complete. The clinical evaluation of the guideline implementation showed improvement in several clinical markers of diabetes care. (Fam Med 2002;34(9):646-8.)