I read with interest the angst around trying to see whether teaching
EBM is effective on patient outcomes. I think Toby Lipman hit the nail
on the head when he wrote
"Surely using patient outcomes is a far too complex end-point for a
study of the effectiveness of EBM?"
The issue of compexity is pivotal in understanding why the
effectiveness of EBM teaching will be ellusive.
The core of activity in general practice (for doctors) is the doctor /
patient / illness relationship. EBM is a technique used by the doctor to
try and influence that relationship so that a desired outcome might be
achieved with respect to an illness.
As a teacher of EBM with undergraduate and post graduate medical
students, I live in the hope that I have an effect on patient outcomes
which those students will create with their future patients. I use the
word "hope" because I am sure that what I teach is at least two steps
back from any patient outcome:
I would encourage research into the various relationships that are
inherent in the steps between the teacher of EBM and the desired
outcomes. We need more qualitative research to answer questions
on relationship issues such as
"How can teachers influence students to take EBM seriously?"
"How do student carry EBM teaching into clinical practice?"
"How do patients perceive the "EBM" doctor" compared to the
"non-EBM doctor?"
Cheers
Marjan
The whole matter is complex because we need to understand that
there is
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