The need for culture of evidence based medicine to “get it all together”
Garner et al. have developed a fascinating framework for shifting the
clinical community towards using systematic reviews and Evidence-Based
Medicine (EBM) in low and middle income countries.[1] However, we have
some concerns about the target population of this framework.
The structure proposed by the authors tries to help implementation of
EBM in a “Top-Down” direction and via targeting groups with specific roles
(“health ministry policy makers, professional groups, and managers with
responsibility for clinical and public health policy”). The authors did
not consider another ‘major’ group of users of EBM. We think that it is
really necessary to consider the resistance of direct care providers (i.e.
clinicians, nurses, dentists, etc) against changes in clinical routines.
In many parts of the developing world, the essential concepts of EBM have
not yet been institutionalized for a considerable proportion of clinicians
and opinion-based medicine still foreruns EBM. Here, “experts” would not
bear many of the external evidences and the need for culturalization about
EBM is really perceived.
Moreover, although this framework seems powerful for changing
behavior of clinicians regarding some common and profound clinical errors,
it cannot change the attitude of clinicians towards EBM and is not
practical for numerous minor clinical errors (which clinicians themselves
should overcome them using EBM). With the suggested approach, rate of
exploitation of many available evidences would not be changed and a
majority of systematic reviews and other valuable evidences would be still
unused.
We think that, beside the proposed framework (for “Top-Down”
implementation of EBM), use of evidences should be promoted by evolution
of ‘evidence-based culture’ among all the members of clinical community
(for “Down-Top” dissemination of EBM). As every other social movement,
culturalization for EBM should be initiated from undergraduate students
and prospective clinicians. Moving toward these goals needs education
frameworks for both policy-makers and clinicians.
1. Garner P, Meremikwu M, Volmink J, Xu Q, Smith H. Putting evidence
into practice: how middle and low income countries "get it together". BMJ
2004;329:1036-9
Competing interests:
None declared
Competing interests:
No competing interests
06 November 2004
Alireza Moayyeri
Research Fellow
Akbar Soltani
Evidence Based Medicine Working Team, Tehran University of Medical Sciences, Tehran, Iran
Rapid Response:
The need for culture of evidence based medicine to “get it all together”
Garner et al. have developed a fascinating framework for shifting the
clinical community towards using systematic reviews and Evidence-Based
Medicine (EBM) in low and middle income countries.[1] However, we have
some concerns about the target population of this framework.
The structure proposed by the authors tries to help implementation of
EBM in a “Top-Down” direction and via targeting groups with specific roles
(“health ministry policy makers, professional groups, and managers with
responsibility for clinical and public health policy”). The authors did
not consider another ‘major’ group of users of EBM. We think that it is
really necessary to consider the resistance of direct care providers (i.e.
clinicians, nurses, dentists, etc) against changes in clinical routines.
In many parts of the developing world, the essential concepts of EBM have
not yet been institutionalized for a considerable proportion of clinicians
and opinion-based medicine still foreruns EBM. Here, “experts” would not
bear many of the external evidences and the need for culturalization about
EBM is really perceived.
Moreover, although this framework seems powerful for changing
behavior of clinicians regarding some common and profound clinical errors,
it cannot change the attitude of clinicians towards EBM and is not
practical for numerous minor clinical errors (which clinicians themselves
should overcome them using EBM). With the suggested approach, rate of
exploitation of many available evidences would not be changed and a
majority of systematic reviews and other valuable evidences would be still
unused.
We think that, beside the proposed framework (for “Top-Down”
implementation of EBM), use of evidences should be promoted by evolution
of ‘evidence-based culture’ among all the members of clinical community
(for “Down-Top” dissemination of EBM). As every other social movement,
culturalization for EBM should be initiated from undergraduate students
and prospective clinicians. Moving toward these goals needs education
frameworks for both policy-makers and clinicians.
1. Garner P, Meremikwu M, Volmink J, Xu Q, Smith H. Putting evidence
into practice: how middle and low income countries "get it together". BMJ
2004;329:1036-9
Competing interests:
None declared
Competing interests: No competing interests