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EDITORIALS: Paul Glasziou, Amanda Burls, and Ruth Gilbert Evidence based medicine and the medical curriculum BMJ 2008; 337: a1253 [Full text]

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“Evidence based thinking” should also be incorporate in elementary and high school curriculum

Ludovic Reveiz, Sylvia de Aguiar   (26 September 2008)

Experience of evidence based medicine

Simon R Thornton   (28 September 2008)

Evidence based medicine, the medical curriculum, and librarians

Keith Nockels   (29 September 2008)

how shall we find the evidence?

Rosemary Fox   (3 October 2008)

Re: how shall we find the evidence?

Onisillos Sekkides   (4 October 2008)

More EBM teaching needed; and more teachers

Paul Glasziou   (7 October 2008)

Is not teaching to take a broad view more important

Raymond G Holder   (8 October 2008)

Teachers need education

Vaidyanathan Gowri   (10 October 2008)

“Evidence based thinking” should also be incorporate in elementary and high school curriculum 26 September 2008
Ludovic Reveiz, Coordinator of General Practice Organizacion Sánitas internacional. Bogota, Colombia., Sylvia de Aguiar Send response to journal: Re: “Evidence based thinking” should also be incorporate in elementary and high school curriculum	A scientific method consists of “the collection of data through observation and experimentation, and the formulation and testing of hypotheses”. Evidence-based medicine (EBM) intend to apply evidence gained from the scientific method to medical practice. It is the process of systematically finding, appraising, analyzing and using research findings as the basis for clinical decisions and problem solving. Glasziou et al (2) suggested that evidence based basic skills of using research “should be taught early and applied as an integral part of learning in all years of the (medical) curriculum”. Actually, “Evidence based thinking” should also be incorporate in elementary and high school curriculum to permit school students to discover the scientific method and to explore the problems according to the evidence. Developing the skills of the school students will also help to incorporate "evidence based thinking" in other fields. 1. From Wikipedia, Scientific method. URL available from http://en.wikipedia.org/wiki/Scientific_method. Access in September 2008. 2. Glasziou P, Burls A, Gilbert R. Evidence based medicine and the medical curriculum. BMJ. 2008 24;337:a1253. Competing interests: None declared
Experience of evidence based medicine 28 September 2008
Simon R Thornton, AF2 Southmead Hospital, Bristol BS10 5NB Send response to journal: Re: Experience of evidence based medicine	There is no doubt that the teaching of evidence based medicine (EBM) should be an integral part of the undergraduate and postgraduate curriculum. Tomorrow's Doctors states "Graduates must know about and understand the principles of treatment including... how to evaluate effectiveness against evidence".(1) The article by Glasziou et al (2) emphasises the importance of EBM within the curriculum but this may be more widespread than the authors portray. Having (relatively) recently graduated from Bristol medical school I feel we received thorough grounding in EBM and critical appraisal. It is one of five key vertical themes that run throughout the five year course,(3) and one of the core components of the Foundation Programme Curriculum.(4) The difficulty comes in regularly applying these skills in a clinical setting, and in my experience this is due to lack of time not good intention. Should formal time be set a side in the 48 hours each week doctors are given to develop all their necessary skills? Probably not. But for those who wish to do it in their own time, might I recommend the BestBETS website which was developed in the Emergency Department of Manchester Royal Infirmary to "provide rapid evidence-based answers to real-life clinical questions, using a systematic approach to reviewing the literature".(5) 1. Tomorrow's Doctors GMC 2002 2. Glasziou P, Burls A, Gilbert R. Evidence based medicine and the medical curriculum. BMJ 2008;337:704-705 3. MBChB Programme Handbook, University of Bristol 2008 4. The Foundation Progamme Curriculum 2007 5. http://www.bestbets.org/ Accessed 28/09/2009 Competing interests: None declared
Evidence based medicine, the medical curriculum, and librarians 29 September 2008
Keith Nockels, Information Librarian University of Leicester Library, Leicester, UK, LE2 7LX Send response to journal: Re: Evidence based medicine, the medical curriculum, and librarians	This is an interesting and well argued piece. Librarians have a vital role in supporting evidence based medicine, using our professional skills to help develop the skills described here. At the University of Leicester, our medical students have compulsory classes with subject specialist librarians, covering searching skills (that we hope enable them to find “potentially relevant studies quickly and reliably”), and sources of evidence based information including the Cochrane Library, Clinical Knowledge Summaries, and DynaMed. Increasingly I am finding myself teaching basic critical appraisal skills across the biomedical sciences as a whole. Clinical librarians in the UK and elsewhere also support practising doctors and other health professionals by searching, selecting and appraising literature on behalf of practitioners who do not have the time, or perhaps the skills, to do this for themselves. Competing interests: None declared
how shall we find the evidence? 3 October 2008
Rosemary Fox, Deputy Director of Screening Services, Velindre NHS Trust 18 Cathedral Rd Cardiff CF11 9LJ Send response to journal: Re: how shall we find the evidence?	It is ironic that the week that the BMJ publishes an editorial on the importance of accessing and critically appraising evidence, staff in NHS Wales have lost the access to electronic databases and journals previously available through the Health of Wales Information Service (HOWIS). This appears to betray a lack of understanding of the importance of evidence based decision making, both in clinical care and policy making. Sadly, unless this decision is reversed, NHS Wales staff will indeed be reliant on Google and Wikipedia for their evidence. Competing interests: I work in NHS Wales
Re: how shall we find the evidence? 4 October 2008
Onisillos Sekkides, Senior Editor London WC2A 1EL Send response to journal: Re: Re: how shall we find the evidence?	Buy a personal subscription to an EBM resource. It's not that expensive, and it'll safeguard your patients and your career. There are several publishers falling over themselves to provide this information, one of them being BMJ Group. Other alternatives are Elsevier's MDConsult or Wolters Kluwer's UpToDate. Competing interests: I formerly worked for Elsevier, and I currently work for a Reed Elsevier Group company.
More EBM teaching needed; and more teachers 7 October 2008
Paul Glasziou, Director, Centre for Evidence Based Medicine University of Oxford, OX3 7LF Send response to journal: Re: More EBM teaching needed; and more teachers	We would be delighted if - as Dr Reveiz suggests - all high school students learned more about scientific method, rather than just the results of science. In addition, they should learn to reason about probability, not simply do probability calculations. Whether or not this happens at school, evidence and probability should certainly be taught in medical school but often is not. According to our recent survey, Simon Thornton is lucky to have attended a UK medical with one of the better curriculums in EBM, but many still have minimal teaching. As we suggested in the editorial, each medical school should have an EBM coordinator who helps to harmonize the teaching from clinicians, librarians (such as those in Leicester), epidemiologists, statisticians, clinical pharmacologists and all those engaged in some elements of EBM so there is a coherent vertical curriculum. Competing interests: Author of the editorial
Is not teaching to take a broad view more important 8 October 2008
Raymond G Holder, Retired engijneer Home BH9 3NF Send response to journal: Re: Is not teaching to take a broad view more important	So much store is set these days on Evidence Based Medicine, but so much that I read rarely takes into account evidence outside the narrow confines of the subject in question. In all science, an ability to see the much broader implications of the question is an essential feature. The implications in other organisms, organs, or functions are studiously ignored, and no thought is given to effects outside the box of the moment. This is seen in the studies and trials which are carried out within the confines of one specialism, with virtually total disregard to the consequences to others. Could this be due to a desire to make the greatest use of research funding solely within the originating establishment or organisation? The public interest is not served by such "possesion" of particular subjects by just one specialism. Treatments for one condition should not merely be measured in isolation, but all the possible ramifications in other areas should be vigorously sought out, without the influence of the "pet" subject of a particular group having the monopoly of decision making on the outcome. Competing interests: Statin damaged patient
Teachers need education 10 October 2008
Vaidyanathan Gowri, Asst professor Muscat, 123 Send response to journal: Re: Teachers need education	Well written article on evidence based medicine. The tutors of the curriculum/consultants in various hospitals need to be taught how to understand research (NOT TO DO research. Only then they can teach the students Competing interests: None declared