By Dr. Gabriela Palis
Evidence-based Medicine (EBM) is the practice of Medicine in a way that integrates the best research evidence with clinical expertise and patient values. This competency is widely recommended to be taught during residency, as a strategy residents should master for finding, appraising and assimilating the best available evidence from studies, and using it for their patients’ care.
Teaching EBM in Ophthalmology can be a challenge for many reasons:
- pre-graduate medical schools not always include EBM in their curricula, so residents’ first contact with this model occurs during residency;
- faculty are sometimes not familiar with the concept;
- ophthalmologists who are knowledgeable of the theoretical concepts that sustain EBM, and who will teach them to residents, are difficult to find for every residency program;
- EBM concepts are difficult to learn and assimilate, so teaching them can be time consuming.
Fortunately, there are some Internet resources that can help teaching EBM. I will describe three free resources I have found very useful:
- Understanding Evidence-based Healthcare: A Foundation for Action (by Kay Dickersin and Musa Mayer).This web course, created by the United States Cochrane Center, was originally designed to help consumer advocates understand the fundamentals of evidence-based healthcare concepts and skills, and is very good as a first introduction to the concepts of EBM. The topics it develops include, among others, what is EBM and why is important; the research questions; research design, bias, and levels of evidence; acquiring, appraising and applying the evidence, etc.
- PubMed® Online: Excellent resource for teaching how to search and find the evidence. It includes PubMed Tutorial (based on the NLM’s one-day PubMed Training Course, in text format with animations, exercises, etc.) and the Quick Tours, animated tutorials with audio for learning how to search PubMed or how to optimize the use of MyNCBI, for example.
- CAT maker at the Center for Evidence Based Medicine (University of Oxford): This software tool helps create Critically Appraised Topics, or CATs, for articles about therapy, diagnosis, prognosis, aetiology/harm and systematic reviews of therapy. The software includes calculators for clinically useful measures and their 95% confidence intervals. With the calculator for therapy studies, for example, you can load the control and experimental event rates, and you automatically get the relative risk reduction, the absolute risk reduction, and the number needed to treat.
In summary, although daily practice and modeling of EBM are essential for learning how to practice EBM, some theoretical concepts are needed in order to understand the process and put it into practice. EBM resources available in the Internet are useful and easy to use tools that could help faculty teach the basis and practice of Evidence-based Medicine
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