NBOME
COMLEX-USA MASTER BLUEPRINT

4. Practice-Based Learning and Improvement in Osteopathic Medical Practice

Overview

Practice-based learning and improvement is the continuous self-evaluation of osteopathic medical practice, utilizing evidence-based medicine approaches to develop best practices that will continuously improve patient experiences of care, reduce inefficiencies and redundancies, and result in optimal and equitable patient care outcomes. Osteopathic physicians must assimilate and apply evidence-based medicine principles and practices, fundamental biostatistical and epidemiologic concepts, clinical decision-making skills, and methods to evaluate relevance and validity of established and evolving scientific evidence. Osteopathic physicians must also appraise the clinical significance of research evidence. Osteopathic physicians must demonstrate the use of best medical evidence, practical strategies for integrating evidence-based principles and practices into patient care, and systematic methods relating to continuous self-evaluation of clinical practice patterns and practice-based improvements, including those that reduce medical errors and promote health. Osteopathic physicians must set learning and quality improvement goals and must incorporate feedback and reflection into daily practice.

Required Elements

4.1 Fundamental Epidemiologic Concepts

DEFINITION The osteopathic physician must articulate and apply fundamental epidemiologic concepts to practice-based learning and improvement. MEASURED OUTCOMES The osteopathic physician must:
  • interpret features and meanings of different types of data, including quantitative and qualitative, and different types of scales (eg, nominal, dichotomous, ordinal, continuous, ratio, proportion).
  • interpret measures of central tendency, including mode, median, and mean, and measures of variability, including variance and standard deviation.
  • explain and interpret measures of frequency of disease, injury, and death in forms of rate, ratio, and proportion, including incidence and prevalence.

4.2 Clinical Decision-Making Tools

DEFINITION The osteopathic physician must interpret literature regarding research and clinical topics for use in understanding disease-oriented and patient-oriented evidence. MEASURED OUTCOMES The osteopathic physician must:
  • conduct, interpret, and apply systematic reviews (eg, meta-analysis) of literature regarding specific research and clinical topics with an understanding of limitations, such as design bias and sources of scientific uncertainty.
  • compare and contrast disease-oriented evidence and patient-oriented evidence in the interpretation of literature.
  • identify and apply population health data to address health care disparities.

4.3 Evidence-Based Medicine Principles and Practices

DEFINITION The osteopathic physician must learn and apply evidence-based osteopathic medical principles and practices. MEASURED OUTCOMES The osteopathic physician must:
  • access the best-available/highest level of evidence, in order to answer a clinical question with accuracy and maximum efficiency.
  • critically appraise the available evidence and its validity, impact, and applicability.

4.4 Clinical Significance of Research Evidence and Statistical Inferences

DEFINITION The osteopathic physician must determine the clinical significance of research evidence. MEASURED OUTCOMES The osteopathic physician must:
  • judge and interpret aspects of statistical inference and hypothesis testing (eg, decision errors, sample size, power, confidence intervals, degree of freedom, blinding, external and internal validity, number needed to treat, number needed to harm, sample size) as applied to osteopathic medical practice.
  • interpret pretest/posttest probabilities in diagnostic and screening tests, as applied to osteopathic medical practice.

4.5 Translating Evidence into Practice and Continuous Learning

DEFINITION The osteopathic physician must apply evidence to clinical practice. MEASURED OUTCOMES The osteopathic physician must:
  • use information technology, including the internet, to optimize learning and to access and manage medical information online.
  • communicate best clinical evidence, including osteopathic principles and practice, to patients and colleagues.

4.6 Continuous Evaluation, Feedback, and Reflection for the Improvement of Osteopathic Clinical Practice

DEFINITION The osteopathic physician must identify, describe, and apply systematic methods relating to continuous evaluation of personal osteopathic clinical practice patterns, practice-based improvements, and the reduction of medical errors. The osteopathic physician must do so using information about individual patients, populations of patients, or communities to improve care. The osteopathic physician must incorporate regular feedback and reflection into practice, as well as set learning and improvement goals. MEASURED OUTCOMES The osteopathic physician must:
  • describe the nature, function, and utilization of strategies in quality improvement (eg, PDCA cycle, six sigma, lean principles, root cause analysis) and health failure modes and effects analysis.
  • consult physician colleagues and engage other health care professionals in the care of patients as appropriate.
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