Editor's Choice

From publication to change

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7405.0-h (Published 03 July 2003) Cite this as: BMJ 2003;327:0-h
  1. Richard Smith, editor

    Medical journals are not good at getting doctors to change their behaviour. There is a substantial gap between the evidence they publish and what doctors do. Nor unfortunately are teachers good at change. Much of the investment in the multimillion dollar industry of continuing medical education is misplaced. Now a group from Toronto has taken a step beyond continuing medical education and developed something they call “knowledge translation” (p 33). The group hopes to shorten the journey between evidence and effect.

    Knowledge translation uses a wide range of methods to achieve change. It's set in practice rather than lecture theatres and uses prompts and various information tools. Rather than being aimed at individual doctors it's aimed at teams, health systems, populations, and policy makers. One of the most interesting differences from traditional continuing medical education is that knowledge translation is aimed at patients as well as doctors. Patients may be more enthusiastic about change than their doctors, and the patient may cause the doctor to change.

    It was because we at the BMJ recognised the long lag between a study being published and change happening that we were initially snooty about fast tracking papers. It usually takes years to do a study and then years for change to happen: why rush around to reduce the time to publication by months? But we came round, following rather than leading, and this issue contains no fewer than four fast tracked papers. These are all studies that might lead to rapid change—partly because they don't depend on urging individuals to change.

    In the first fast tracked paper Ben Bridgewater and others argue that it may be best to compare cardiac surgeons by using data from low risk patients—partly to ensure that surgeons don't avoid high risk patients (p 13). This study could lead to change because, as the authors write, “there is an unstoppable momentum towards the publication of surgeon specific mortality” but it isn't clear how best to do that.

    The study by Giuseppe Traversa and others has been fast tracked because its data should help drug regulatory authorities decide whether to ban nimesulide, a non-steroidal anti-inflammatory (NSAID) drug (p 18). The drug is banned in Finland and Spain because of hepatotoxicity, but it's the most commonly used NSAID in Italy. Authorities are deciding now whether to ban the drug. The study suggests that the risk of liver injury is low with nimesulide and other NSAIDs.

    The two other fast tracked studies both relate to training ambulance crews to give thrombolysis. One study shows that its feasible (p 27) and the other that it can reduce call to needle time dramatically (p 22). The result should be lives saved. Making this happen doesn't depend on urging individuals to change but rather on changing the way services are organised—although an individual in each area has got to start the process of change.


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