Teaching EBM to medical students: role of Medical Academies

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Teaching EBM to medical students role of Medical
Academies

• Prof. Farida Ayupova,
• Second Tashkent State Medical Institute

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CONCEPT EVOLUTION

• Evidence-based
• medicine is an integration of the best clinical
  practices facts and patients preferences
• Sackett D. et all, 2000

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Number of Internet articles containing key words
EVIDENCE-BASED MEDICINEyearly
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If we only knew what we know

• At present, can we state with confidence that all
  the technologies used in modern medicine are
  effective, most appropriate and safe?
• Primary idea of EBM is very simple applying to
  practice only those methods of treatment and
  diagnostics, the effectiveness of which has been
  proved by strict scientific principles of
  clinical researches
• Increased number of Drugs-Related Researches

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If we only knew what we know

• No clinician is capable of possessing enough
  experience, to easily solve multiple and complex
  clinical situations
• Unreliable memory of knowledge

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IS MEDICINE TURNING INTO A RECIPE BOOK?

• Find the best recipe and apply it

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Problems of searching required information

• The volume of medical literature increases by
  6-7 a year.
• During the study period until the moment of
  starting medical practice the volume of
  literature will increase two times.
• About 20,000 medical journals are published
  worldwide.
• Annually, 4,000,000 articles are published in
  these journals.

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• Doctors do not have time to track an up-to-date
  information
• Patients management can significantly differ
  between doctors at different health facilities
• Interventions, the effectiveness of which has not
  been proved by reliable researches, are widely
  applied
• Patients preferences do not receive due
  attention (No informed consent)

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• Clinical epidemiology increases the
  understanding and interpretation of information,
  because a doctor would quickly determine which
  articles or sources of information have
  scientific validity. This provides a more solid
  foundation for making clinical care decisions
  than relying only on commitment, eloquence,
  professional background and specialty experience
  of providers with different opinions.
• R. Fletcher, S. Fletcher, E. Vagner. Clinical
  epidemiology. EBM Basic Principles

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Non-evidence-based medical practice is based on

• Doctors credibility (work experience replaces
  updated knowledge because it relies on old
  practices)
• Temper (emotional influence on other colleagues
  and patients relatives)
• Appearance and eloquence (nice suntan, silk tie,
  impressive pose and eloquence as replacement for
  evidences)

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Non-evidence-based medical practice is based on

• Guessing and foreseeing (when it is not known
  what to do with a patient, then instead of using
  a well-grounded solution, they rely on Gods
  will)
• Sense of uncertainty (decisions are not taken
  because of lack of access to information and
  guidelines)
• Nervousness (in the conditions of constant fear
  of lawsuit a doctor prescribes excessive
  examination and treatment)
• Self-confidence (only for surgeons)

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Summary or why teachers need epidemiology

• Sometimes, students can be curious and want to
  know Why? Where from?
• Teachers need to publish their work not only in
  local books or oblast-level conferences materials
• Besides, teachers provide treatment and should
  know better

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Programme of the Conference Introduction of EBM
Principles into Educational and Scientific
process and into Clinical Practice.

• Epidemiology is the basis of EBM.
• Factors influencing on making decisions in
  medicine.
• Methodology of medical investigations.
• Analysis and use of basic epidemiological
  findings.
• Mistakes in investigations and how to get rid of
  it?
• Use of basic epidemiological findings.
• Adaptation of methods of descriptive statistics
  in medicine.
• Analytical statistics as an instrument of
  conclusive medicine.
• Standardization in medicine.
• Analytical statistics.
• Critical reading of publications.
• Assessment of medical technologies.

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A compromise between willingness and feasibility
is needed
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Thank you for attention!