I would not be so pessimistic -
i believe ebm works at two levels
one is this searching, hit rate, evidence part which is mostly difficult -
but occaisonally surprisingly easy and rewarding -
the other level i believe is more important. Instead of just giving the
drug or doing the test you are questioning.
you may not find the answer but surely the questioning approach makes you a
better doctor?? given the "sure and possibly ignorant" doctor vs the
"unsure and questioning" doctor I know who I would want to look after me.
martin
-----Original Message-----
From: Ronald Ingle [SMTP:[log in to unmask]]
Sent: 14 December 1998 20:21
To: [log in to unmask]
Subject: Re: Teaching EBM in real time
Andrew Booth refers to
- The few articles there are about the most common problems
- The need to access full texts (this problem of hard copy was highlighted
not long ago)
- Pessimism [due to poor hit rates]
- Neverthelss giving it a go
- But that [succcessful] teaching in real time needs "some degree of
success".
I am associated with a Masters programme in Family Medicine. Frankly EBM in
South Africa is, I judge, embryonic. I find the techniques of effective
electronic searching alone - as this List bears witness - are pretty
demanding. To prepare myself to be semi-competently resourceful about it to
the guys out there in our bushface is quite a learning curve. The amount of
suggestive advice and experiences on this List on all aspects of the
process from Question to Application has been remarkable and enlightening.
Thanks indeed.
BUT, as Andrew hints, there is this worrying doubt about the exercise. For
me, the opportunity to introduce and put it across - hands on if possible
of course - [we have a part-time, self-directed, distance learning
programme] will be limited. The aim will be to provide enough insight for
the guys to lift off on their own. The doubt comes in about the sincerity
of "setting up" a successful demo and practice search to show what CAN
result when, considering the sort of real life circumstances Andrew
mentions, the chances are so low of them having encouraging degrees of
successful searches in their real time problems (not to mention their
African context] which we will have encouraged them to go for. It seems to
me its going to take time a) for primary care based research to gather
momentum, b) for it to become databased, let alone c) being systematically
reviewed. Skilled medical librarianship to help (the offers of which,
waiting to be tapped into, in the "first world" have !
al!
so appeared on the List) is at an utter premium. There is also the well
ventilated problem of downloadable full text vs hard copy.
I recognise the value of the DLS-style optimism for getting the whole show
well onto the road. And that that evangelical fervour is needed anywhere in
the world for progress. But I have these big doubts about trying to show
(GENERALISE) that this is for every GP and Rural Doctors' to get into now.
I am beginning to try to conceive a kind of Phase One strategy like for
improving clinical reasoning and decision making, acknowledging clinical
uncertainties, making better use of existing resources. Only pointing the
way to and supporting those who can handle the generally rather barren
fruits, with bursts of serendipity, that "the Net" will offer them at
present (self-directed learning at its most challenging of course).
Or maybe this angst (bear with me for thinking out loud) and the sincerity
thing is best dealt with by being totally honest about hit rates at
present. Come to think of it, maybe that may be good too, for showing guys
the reality of what many think is a buzz to be into. Will it so to speak
sort the men from the boys? Maybe, like a lot of things in life, it is the
training and role modelling at undergrad level which will work (as also
appears on the List). For the rest of us it just has to be catch up stuff
anyhow?
I had better send all this tonight, before rubbing it out in the cold light
of the morning. Sorry if I should have anyhow.
Ronald
Dr Ronald Ingle
Senior Lecturer, Family Medicine
Medical University of Southern Africa
Pretoria
0204 South Africa
Email [log in to unmask]
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