By Nicole Fauteux
Bring up the topic of teaching evidence-based dentistry
(EBD), and it won’t be long before someone mentions CATs, and once the
conversation turns to CATs, the name Dr. Rugh is almost sure to follow.
Dr. John Rugh did
not invent Critically Appraised Topics (CATs for short), but he can be credited
with seeking out this pedagogical tool, adapting it for dental education,
championing its use at his home institution—the University of Texas Health Science Center at San
Antonio (UTHSCSA) Dental School—and helping to spread the word about
EBD from there.
Collectively, CATs is one of several tools currently in
use for teaching medical and dental students—and practitioners, for that
matter—the skills they need for evidence-based practice. The lessons learned
through these single-page evidence summaries include:
a focused question
searching the scientific literature
the quality of the available evidence
clinical judgments about its applicability to the clinical situation at hand
Dr. Rugh’s interest in CATs grew from his concern about
the slow pace at which new scientific knowledge is transferred to the practice
“It takes about 14 to 16 years for medical
science to make its way into private practice,” he estimates. “It’s not clear
how long it takes in dentistry (the research is not as extensive), but it’s
probably about the same.”
Confronted with this problem, it’s no surprise that this
former Director of Research for the Dental School and Past President of the
American Association for Dental Research turned to the literature. He
discovered the use of CATs to teach evidence-based practice in medicine and saw
the method as a way to raise awareness of the importance of EBD among dental
students and faculty.
In 2007, Dr. Rugh presented a seminar at UTHSCSA that
outlined his vision and rationale for incorporating CATs into the dental school
curriculum. By the end of the following year, an implementation plan was in
place, a third of the faculty was trained in the use of CATs, students had
received their first exposure, and Dr. Rugh had received a four-year National
Institutes of Health Education (R25) Research Grant to continue training the
faculty and assessing the new EBD program.
Today EBD skills are taught and employed in all four years
of the predoctoral program and in some residency programs as well.
“There has been a cultural shift within the school,” says
Dr. Rugh. “People have bought into the EBD principles. They may be overwhelmed by
other stuff, but they see that CATs are workable in different classes, cost
effective, and can be implemented at various levels. We’re 85% of the way
toward integrating EBD throughout the curriculum.”
Every UTHSCSA predoctoral student is currently expected to
write two to three CATs with a faculty mentor. Eighty-two faculty members serve
as mentors and receive academic credit for their CAT publications. These are
collected in an online
which opened to the public in 2011. To date, the library has received more than
50,000 page views worldwide with about 30% coming from patients and 35% coming
from the TRIP Database,
an international search tool designed to allow health professionals to
access clinical evidence. The CATs are reviewed and updated annually, and
library visitors are encouraged to post comments.
widespread embrace of CATs at UTHSCSA has drawn the attention of other dental
schools. Dr. Rugh has spoken at about eight of these. Some are implementing
CATs programs of their own. Others are using the CATs library at UTHSCSA as a
resource for their own EBD assignments.
Dr. Rugh, bringing CATs to UTHSCSA has been “one of the most fun,
exciting, and satisfying things I have done in my educational career.” In his
view, people with doctoral degrees (he includes himself) have traditionally
focused too heavily on teaching predoctoral students to do science when they really needed the skills, knowledge, and
judgment to use science well.
“With CATs,” he observes, “it’s gratifying to see that
students are embracing this, and that they leave here with skills that are of
value to them.”