Challenges of teaching EBM

As a clinician at an academic institution and possessor of a master's degree in clinical epidemiology, I support the principles of evidence-based medicine (EBM). Nevertheless, I have found it a challenge to teach EBM, primarily because it is a significant challenge to practise EBM. The series by Peter Wyer and associates,1 especially the “tips for teachers” components, will go a long way toward assisting in the instruction of EBM, but unless trainees can use EBM practically and witness their teachers using it practically, we will not achieve the goal of EBM becoming a core competency of the next generation of physicians.

Part 1 in the series is an example.2Using tip 2 (“Balancing benefits and adverse effects in individual patients”) requires information on the background risk. This in turn requires efficient access to the types of information cited in the article.3^,4 Efficient and effective access to that kind of information in most settings — either the over-busy hospital ward or the private office — is a challenge. (Ease of access is not a problem, because of ubiquitous Internet connectivity and the plethora of databases.)

In some areas of practice (particularly cardiovascular disease and cancer) information is available to feed into EBM approaches, such as the results of randomized controlled trials, background risks and other epidemiologic data. In other specialty fields, however, such as pediatrics, those data do not exist. In generalist fields such as family medicine the problem is the huge variety of patients and the constant shift from simple to complex conditions across age groups.

Two factors have hindered adoption of EBM: the challenge of teaching this material and the challenge of applying it. This series will (hopefully) help to address the former, but we have not done enough about the latter.