The challenge of EBM is not only in teaching the tenets of EBM to students,but to make it more user friendly. The usual instruments to teach EBM( math) is slightly different from traditional didactics of medical education. 'Tell me the answer and the best way to do things' seems to the prevailing norm. Works well even now, despite all that has been said against it.
Certainty of medical diagnosis, quick criticism of probabilitic thought process and a variable tolerance of physicians ( Martha Gerrity's work from Oregon)for uncertainty, makes practicisng EBM a challenge.
Getting an agreement within this group of EBM pundits is probably not going to be difficult, however using EBM real time on a consistent basis by teachers and students alike is the real challenge.
Ongoing research incorporating educational theory, constant role playing by faculty will be required to get EBM estabilished as a routine way of practicing medicine and not the choice of a selected few.
Medical uncertainty cannot be avoided and EBM will generate additional uncertainty. This fact is often ignored in teaching EBM.
Amit K. Ghosh
Mayo Clinic
> ----------
> From: Jim Walker[SMTP:[log in to unmask]]
> Reply To: Jim Walker
> Sent: Monday, September 08, 2003 3:04 PM
> To: [log in to unmask]
> Subject: Re: Evidence based teaching
>
> Benjamin,
> Well said.
> Evidence-based practice is much more intellectually demanding than we are prone to give it credit for, and we are very early in the process of developing tools to make its practice feasible.
>
> Jim
>
>
> James M. Walker, M.D.
> Chief Medical Information Officer
> Geisinger Health System
> [log in to unmask]
> 570 271-6750
> Internal Mail Code 30-06
>
>
> >>> "Djulbegovic, Benjamin" <[log in to unmask]> 09/05/03 10:00AM >>>
> I think we should not be so quick to dismiss the criticism about the value of EBM that the recent e-mail raised. After teaching various courses on EBM (since 1997) and the attempts to integrate it in my own practice, I am not so sure how FEASIBLE is to teach EBM at bedside. Medicine is primary problem-solving and decision-making exercise. While we have all argued over the years that understanding the nature and quality of evidence etc is a key to practice of medicine, the original EBM paradigm (ask-search-appraise-decide) is simply very difficult to apply in practice. The primary reason, of course, is time-constraint. When my team has 20-25 of acutely ill patients on the ward and admit and discharge every day 3-7 patients, it is impossible to approach decision-making and problem-solving in EBM structured way. So, in practice, instead of serving as a facilitator, I end up spoon-feeding that necessary knowledge, which students, residents, fellows are supposed to discover on !
their own. When I don't know the answer, then we call consultants to help us with our questions. We simply don't have time to go through EBM process (despite the fact that I work in high-tech surroundings with computers at every corner, linked to any database you can think of...of course, we have journal clubs, teaching conferences, educational objectives, assignments and all that...we even do decision models, meta-analyses, understand the differences between normative vs. descriptive vs. prescriptive decision making etc). However, at the end of the day, it is CONTENT > (i.e. content-specific expertise) that wins the day and not the process, or method-oriented approach which EBM paradigm promised. That is, the consultants (from the various disciplines who may or may not be of EBM kind) are the one whose advice you will follow (99% of time) regardless if that advice is EBM formulated or not. Several years ago I have been dreaming (and still do) that we will be able to identi!
fy all high-quality evidence (in my field, hematology and oncology), which we will then pre-processed and have at finger-tips at the bedside. Other folks have done the same in other areas of medicine. While I am still hoping that "thrill is not gone", EBM (and related initiatives including decision-analysis) has to face the key aspect of clinical medicine: LIMITED TIME FRAME FOR DECISION-MAKING UNDER CIRCUMSTANCES OF UNCERTAINTY.
>
> I am hopeful that this e-mail, which I wanted to send for some time, but did not have time, will help stimulate some constructive debate.
>
> Benjamin Djulbegovic, MD,PhD
> Professor of Oncology and Medicine
> H. Lee Moffitt Cancer Center & Research Institute
> at the University of South Florida
> Department of Interdisciplinary Oncology
> SRB #4, Floor 4, Rm #24031 (Rm# West 31)
> 12902 Magnolia Drive
> Tampa, FL 33612
>
> Editor: Cancer Treatment Reviews (Evidence-based Oncology Section)
> http://www.harcourt-international.com/journals/ctrv/
>
>
> e-mail:[log in to unmask]
> http://www.hsc.usf.edu/~bdjulbeg/
> phone:(813)979-7202
> fax:(813)979-3071
>
>
>
> -----Original Message-----
> From: badri badrinath [ mailto:[log in to unmask]]
> Sent: Friday, September 05, 2003 8:57 AM
> To: [log in to unmask]
> Subject: Evidence based teaching
>
>
> Dear Andrew,
>
> Greetings from sunny Southend on the English coast.
>
> You wondered "why teaching does not seem to have picked up on EBP"
>
> There are some initiatives in this direction. Here are a few examples.
>
> http://www.bemecollaboration.org/
> Some of the topic reviews look very interesting.>
> http://www.bemecollaboration.org/topics.htm
>
> http://education.ntu.ac.uk/research/ebt/ Evidence based teaching in primary
> school.
>
> http://nursing.jbpub.com/catalog/0763709379/ A text on Evidence based
> teaching in the area of nursing.
>
> Cheers & regards and have a wonderful weekend.
>
> Badri
>
> Dr.P.Badrinath M.D.,B.S.,M.Phil(Epid).,PhD(Cantab).,MPH., MFPHMI
> Specialist Registrar in Public Health Medicine,
> Southend PCT, Harcourt House,
> Harcourt Avenue, Southend-on-Sea,
> Essex SS2 6HE, UK
> http://myprofile.cos.com/badrishanthi
>
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