…or is it a subject?
This was one of the questions raised at the pre-conference workshop on “EBM curriculum development” that I attended today. I must admit that this threw me a little – of course it is a subject!?! It is a way of life too, but surely students need to learn what it is all about before they adopt it as a way of life?
As you can imagine, this turned into quite a discussion. Some people firmly believe, that EBHC should not be taught to undergraduates – as a subject. They should, however, be exposed to it through the way their teachers role model EBHC. Assuming that undergraduate students adopt the clinical behaviour of their teachers, this would lead to them ultimately practicing EBHC. Therefore, it would be most important to teach EBHC to the lecturers and clinicians, so that they can become good role models. But surely this then becomes a subject again? And – how easy is it to convince senior clinicians to change the way they make clinical decisions (and teach these to students)?
Another question related to undergraduates was raised: Should they know how to critically appraise different types of studies, or should they only know how to access synthesised research and summaries thereof found in databases like Up-to-date and The Cochrane Library? Some people thought that we should be teaching “information mastery” instead of EBHC to undergraduates.
Others argued, that EBHC teaching and learning fits better into the postgraduate curriculum, where students would be more receptive to the principles of EBHC and have a better understanding of how EBHC could be used in practice… but what about those graduates that never continue their studies? This would mean that they would never be exposed to formal EBHC training, unless they attended CME courses. Would this be adequate?
There were also other delegates who believe, like me, that EBHC should be introduced early in the medical curriculum – so that it can be integrated in clinical teaching and ultimately become a way of life. This teaching should continue at postgraduate level. Medical graduates, whether they continue studying or not, should be competent in asking questions, searching for literature and critically appraising the literature. They should also be aware of existing summaries and how to access these – but I do not think this is sufficient.
There are different opinions and certainly a lot of questions that remain when we think about teaching EBHC to students. I really liked the way one of the delegates described it: Learning EBHC is like learning how to drive a car: at first, you think about every step: clutch control, when to change gears, how to park etc. Uuntil it becomes an automatic, intuitive process you can almost do in your sleep. A curriculum on EBHC can thus be seen as the keys to this car, an essential component to ignite EBHC learning.
I think EBHC should start as a subject for every health care student – so that it can become a way of life.
In the afternoon, I had some time to explore Delhi – This is the tomb of Humayun