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EBM第五步驟 – 成效評估 台北場陳杰峰ppt 張維君講述 2013.09.15 8:30-8:50am -- 實證醫學種子師資培訓工作坊(台中場) The 5th step in practicing EBM is self-evaluation. (Ch.8, p.205) Evidence-based medicine-How to practice and teach EBM—Sharon E.Straus, et al, 4th ed. 2011 Reflective practice省思 John Dewey (1933): ”reflective thought” 約翰?杜威( 1933 )：“深思反省的思維” State of uncertainty due to a difficulty in understanding an event or solving a problem一種不確定的狀態，源自於一事件的難以瞭解或是難以解決 Definition of the difficulty by understanding the nature of the problem根據常識，問題本身自有其難度在 Occurrence of a possible solution, through inductive reasoning經由歸納性推斷，可能有解決方案 Rational elaboration of ideas produced through abstract, deductive thought focusing on implications經由著重在應用的理論推演下所產生的合理解決方案 Testing resulting hypotheses by overt or imaginative action藉由顯而易見或是想像事件來檢測假設結果 Donald Sch?n (1983): “reflective practitioner” ”省思實踐者“ Reflection-on-action對於事件的省思 Reflection-in-action進行中的省思 Reflection: “considering the larger context, the meaning, and the implications of an experience or action”省思：“更深入去細想一經驗或事件的來龍去脈，意義，及所牽連的事項” Reflection-on-action對於事件的省思 Understanding what just happened了解剛發生什麼事 Example: “How do you think that went?”舉例：“你認為如何會發生呢？” Reflection-in-action進行中的省思 Simultaneously performing while making continuous adjustments according to what you discern about the process在進行過程中當察覺到有其需要，一方面進行，同時持續作修正 Example:舉例： The baseball pitcher棒球投手 The jazz musician爵士樂手 Sch?n, 1983 實證醫學五步驟 問題形成 文獻評讀 臨床應用 評估 資料搜尋 問題形成 評估小卡1-評估我們的表現：提出一個可以回答的問題 5 非常同意 4 同意 3 普通 2 不同意 1 非常不同意 我到底有沒有提出任何臨床問題？ 我提出的是焦點問題嗎？ 我可以使用“地圖”找出我的知識不足所在，並建構問題嗎？ 在提出問題時，我可以令自己毫不猶豫嗎？ 我有方法保留問題，以便稍後回答嗎？ Am I asking any clinical questions at all? Am I asking focused questions? Am I using a map to locate my knowledge gaps and articulate questions? Can I get myself “unstuck” when asking questions? Do I have a working method to save my questions for later answering? Evidence-based medicine-How to practice and teach EBM—Sharon E.Straus, et al, 4th ed. 2011 評估小卡 問題形成-1 我到底有沒有提出任何臨床問