Evidence-based medicine
Evidence-based medicine
Evidence-based medicine (EBM) is a movement which aims to increase the use of high quality clinical research in clinical decision making. EBM had its roots in 19th century Paris, but really got going in the 1990s when the explosion of medical information and information technology made it feasible to search computerised databases easily and rapidly for the best, most up to date evidence. Now, it is also driven by the involvement of consumers in medicine and the move towards shared clinical decision-making.
Practically, EBM is about finding out what the patient wants to know and the best possible evidence on which to base answers. The sorts of questions patients ask have, over time, driven clinically relevant research into (for example):
- the accuracy and precision of diagnostic tests (including the clinical examination),
- the power of prognostic markers, and
- the efficacy and safety of therapeutic and preventive interventions.
The University of Sydney has recognised the importance of producing graduates with skills in EBM and is one of a small number of Universities that teach EBM to undergraduate students. This enables students to develop EBM skills from the outset of their clinical training, and to foster an ongoing desire to practice EBM.
Years 1 & 2
In years 1 and 2 of the Medical Program EBM teaching aims to assist students to formulate focussed clinical questions, to literature search effectively, and to find and appraise clinical research. EBM is integrated into the rest of the students learning so that it is seen as part of the process of acquiring preclinical and clinical knowledge and skills. In the problem-based learning (PBL) process, EBM prompts and activities have been designed to simulate EBM in clinical practice.
This integrated teaching is supplemented by EBM specific teaching – in the form of interactive theme sessions and small group tutorials each block, with a different skill addressed each block. For example, block 1 covers formulating clinical questions, block 2 study designs in epidemiology, and subsequent blocks cover critical appraisal of studies on questions of prognosis, aetiology, intervention and diagnosis.
Years 3 & 4
In years 3 and 4 the students build on the skills learnt in years 1 & 2 and, in addition, begin to apply clinical research to clinical practice. Over the two years students are involved in a range of innovative EBM activities, and have many opportunities to take their theoretical EBM knowledge and put it into practice. One example is ‘PEARLS’, where the students find a patient in their clinical encounters and formulate a clinical question of relevance. In a series of tutorials, they develop their search strategy, conduct the search, find the best quality evidence, appraise it and present it to their colleagues and teachers in a formal presentation. [Note: PEARLS = Presentations of Evidence Abstracted from the Research Literature for the Solutions of real individuals problems.]
The University of Sydney is committed to training doctors for the 21st century – and that means doctors who can deal with information explosion and the increasing demands from the profession, government and consumers for evidence based practice. Sydney University graduates will be well equipped to cope with the challenges of the next century and will be in a strong position to lead the way in evidence based practice and shared clinical decision-making.