Original Article Academic Psychiatry, 32:6, November-December 2008 http://ap.psychiatryonline.org 475 Guided Mentorship in Evidence-Based Medicine for Psychiatry: A Pilot Cohort Study Supporting a Promising Method of Real-Time Clinical Instruction Anthony Joseph Mascola, M.D. Received March 20, 2007; revised July 17, 2007; accepted July 25, 2007. Dr. Mascola is affiliated with the Department of Psychiatry and Behavioral Sciences at Stanford University in Stanford, Calif. Address correspondence to Anthony Joseph Mascola, M.D., Stan- ford University, Psychiatry and Behavioral Sciences, 401 Quarry Rd., Mail Code 5722, Stanford, CA 94305-5722; amascola@ stanford.edu (e-mail). Copyright  2008 Academic Psychiatry Objective: Evidence-based medicine has been promoted to en- hance clinical decision making and outcomes in psychiatry. Res- idency training programs do not routinely provide instruction in evidence-based medicine. Where instruction exists, it tends to occur in classroom settings divorced from the clinical decision- making process and is focused narrowly on appraisal of evidence quality. The goal of this pilot study was to develop and evaluate the promise of a method of “hands-on” instruction in evidence- based medicine done in real clinical time. Methods: A modularized curriculum to promote decision- making strategies using evidence-based medicine during the course of actual patient care was delivered by an attending phy- sician mentoring a small team on the inpatient and consultation- liaison psychiatry services at Stanford. A staggered cohort of 24 consecutive trainees was followed between August and January 2007. Measures of trainees’ skills in evidence-based medicine were assessed before and after mentoring. A blinded grader scored each inventory according to an explicit, predefined rubric. Demonstrated proficiency in delivery in each of the core skills of evidence-based medicine was assessed as a secondary outcome measure via the attending physician’s unblinded subjective eval- uation of trainee performance. Subjective descriptions of the ex- perience were obtained via review of trainees’ evaluations. Results: Postmeasures of knowledge and skills in evidence- based medicine increased significantly relative to baseline. The Cohen’s d effect size was large and clinically meaningful. The majority of trainees were able to demonstrate adequate profi- ciency of skills by attending subjective evaluation. Trainees’ sub- jective experiences overall were positive. Conclusion: Guided mentoring in evidence-based medicine ap- pears promising for further study. Academic Psychiatry 2008; 32:475–483 E vidence-based medicine (EBM) has been defined as “the conscientious, explicit and judicious use of cur- rent best evidence in making decisions about the care of individual patients” (1). EBM promotes integrating criti- cally appraised research evidence, clinical expertise, and the patient’s unique values and circumstances in a collab- orative, shared decision-making model that aims to opti- mize outcomes (2). The EBM model has been operation- alized into a series of five steps sometimes referred to as the 5As (2): asking focused, answerable questions useful in efficiently querying electronic repositories of published literature; acquiring high quality evidence rapidly to an- swer such questions; appraising evidence found for its rele- vance, validity, and importance; applying the findings of information found appropriately by considering the strength of the evidence discovered, the clinician’s judg- ment of the generalizability of the evidence found to the individual clinical situation encountered, and the patient’s values and preferences; and assessing the outcome of the implemented decision as well as the process used in reach- ing it. Detailed procedures for implementing each of the five steps have been well described (1–10). Several persons have advocated for increased adoption of the EBM model in mental health care settings in an effort to improve the quality of care given to patients (3, 4, 6–14). Proponents of EBM believe that more optimal medical decision making can be achieved by increasing cli- nician awareness of potential biases that can influence