Tuesday, December 30, 2014

How are medical students taught EBM?

Here's a systematic review. Some sections of particular interest:

Sixty-seven percent of interventions indicated that they trained learners to search PubMed 15, 18–21, 23–25. In three interventions 14, 16, 17, MEDLINE, a subset of PubMed, was mentioned as a distinct information resource for which students received training. In one instance, MEDLINE was accessed via Ovid 17, whereas in the two other interventions, it is unclear if MEDLINE was introduced via the PubMed interface or via a subscription service, such as Ovid or EBSCO.

In addition to PubMed, a spectrum of information resource types was introduced, including UpToDate (25%), AccessMedicine (17%), DynaMed (17%), Google (17%), Cochrane EBM Reviews (8%), DxPlain (8%), National Guideline Clearinghouse (8%), and ACP Journal Club (8%).

The findings represent a shift form the original pure teaching of user appraised primary searching (e.g. PubMed) to pre-processed (filtered) resources. As I have pointed out before this is an evolving and controversial area.

From the discussion section:

EBM advocates encourage physicians to provide their patients with best evidence as a component of the EBM process and shared decision making 46. However, best evidence that is valuable to a physician, such as a meta-analyses featured in PubMed, may or may not be of value to a patient due to its complex nature. Therefore, it is notable that only a single training presented a consumer health information resource. This is a valuable missed opportunity for librarians, who have a long history of promoting consumer information 47, to introduce medical students to these important tools, which can facilitate the shared decision-making process and empower the patient. In the future, librarians should consider introducing consumer health resources into EBM training.

This raises another controversy: is it the physician's job to translate the evidence into plain language for the patient or should the patient access consumer oriented filtered resources as a part of shared decision making? Either way the authors understand the importance of patient preferences and values as key components of EBM.

Today's policy makers who advocate for top-down and population-based medicine deny this aspect and are thus opposed to EBM whether they admit it or not.

No comments: