WARNING: a lot of cynicism in this post.
I have been revamping my EBM course that I teach at the medical school. As I’ve been doing this I realize we (the collective EBM teachers of the world) teach knowledge and skills that I don’t think are used very often once our doctors are out of residency.
Who really develops a PICO question in the clinical setting (outside of an academic center)? Who is really doing database searches? (I think everyone just goes to Google, UpToDate or Dynamed and doesn’t care if studies are potentially missed.) How many critically appraise the primary literature? (Don’t most probably just read the conclusions from the abstract? or assume the study is good?) How many really understand how to “manipulate” findings of a study to adapt them to the patient they are seeing?
I know this seems like a negative post but practicing EBM is hard. It is a complex task that takes time and feedback to master. Once you leave training there is little feedback you will ever get on EBM skills. So they wane and all that can be done is to keep practicing like they have been by relying on experience, collective knowledge of consultants, and using Dr. Google. But how bad of a service have they provided their patients by doing this? Probably not all that bad.
As an educator I feel these skills are important and I think I have designed my course to provide the best chance for students to remember the material. But I don’t know how to convince practicing docs that they need to keep brushing up on EBM skills. I also don’t know what I would tell them if they asked “Well how do you want me to brush up on my EBM skills?” EBM skills should probably be a reasonably important part of the MOC process. Aren’t these skills key to actually keeping up?
Now its your turn. Tell me where I’m wrong and what should practicing docs do?
Good Morning Terry,
One way clinicians can stay current and even expand their EBM skills is to check with their professional association and find out if they can get involved in a clinical practice guideline development project. Participants on these panels can leverage their clinical skills while honing their EBM skills and contributing to their field (i.e., if the guideline is published they get their name on a paper). Other benefits include knowing the relevant literature, deepening their expertise, and gaining respect from their colleagues.
It’s hard to get on these panels but this would be a way to keep ebm skills up
I agree. The same people tend to be on these panels over and over. I think their BODs like to stick with the people they already know rather than give a new person a chance.
I agree perhaps not much practiced in the day to day ward rounds and clinics. However we now follow guidelines which I hope are evidenced based. As program director for general surgery i organize a journal club every month and that is as much as we can do. I think we need to look at our way of teaching evidence based medicine and make it a daily reality. Don’t know how though. Regards
Being able to accurately interpret a study is hard; being able to apply those results to an individual patient is harder; being able to communicate to a patient what to expect from a particular intervention may be the hardest!
PS: Would you mind sending my your course syllabus?
You can get if off my course website at medicine.uabebm.com. You will have to register to get access but you won’t get any email or spam.
Will be interesting to see what others say if you post this in the EBM forum.
Also, just wanted to say all your post are very interesting yet concise. Please keep posting!