BACKGROUND: Evidence-based medicine (EBM) is widely taught in residency, but evidence for effectiveness of EBM teaching on changing residents' behavior is limited. OBJECTIVE:To investigate the impact of an EBM curriculum on residents' use of evidence-based resources in a simulated clinical experience. DESIGN/PARTICIPANTS:Fifty medicine residents randomized to an EBM teaching or control group. MEASUREMENTS:A validated test of EBM knowledge (Fresno test) was administered before and after intervention. Post intervention, residents twice completed a Web-based, multiple-choice instrument (15 items) comprised of clinical vignettes, first without then with access to electronic resources. Use of electronic resources was tracked using ProxyPlus software. Within group pre-post differences and between group post-test differences were examined. RESULTS:There was more improvement in EBM knowledge (100-point scale) for the intervention group compared to the control group (mean score increase 22 vs. 12, p=0.012). In the simulated clinical experience, the most commonly accessed resources were Ovid (71% of residents accessed) and InfoPOEMs (62%) for the EBM group and UptoDate (67%) and MDConsult (58%) for the control group. Residents in the EBM group were more likely to use evidence-based resources than the control group. Performance on clinical vignettes was similar between the groups both at baseline (p=0.19) and with access to information resources (p=0.89).CONCLUSIONS: EBM teaching improved EBM knowledge and increased use of evidence-based resources by residents, but did not improve performance on Webbased clinical vignettes. Future studies will need to examine impact of EBM teaching on clinical outcomes.KEY WORDS: evidence-based medicine (EBM); changing residents' behavior; EBM curriculum.

Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiologic diagnosis that has become more widely recognized and reported over the past few decades. As such, there are a number of known risk factors that contribute to the development of this syndrome, including volatile blood pressures, renal failure, cytotoxic drugs, autoimmune disorders, pre-eclampsia, and eclampsia. This report documents the first reported case of PRES in a patient with severe alcoholic hepatitis with hepatic encephalopathy and delves into a molecular pathophysiology of the syndrome.

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