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Evidence-based medicine: a rising paradigm
La medicina basada en la evidencia: un paradigma en ascenso
Silvia Del Rosario Huaillani-Chavez1* https://orcid.org/0000-0002-8266-1851
1National University of San Marcos. Lima. Peru.
*Author for correspondence. Email: akizul@gmail.com
ABSTRACT
Evidence-based medicine is not a new paradigm in theory but in practice. Its application in the areas of health is a guarantee of improvement in patient care, and in the higher level educational centers it strengthens the competence of searching, critical reading and evaluation of the evidence before a clinical case by the students; in spite of this, it is still not possible to position it because there is some resistance for those who consider the medicine based on experience more effective. Therefore, the present research paper offers an overview of the need to raise awareness of the efficacy of evidence-based medical practice in the medical care and education fields.
MeSH: medicine; evidence-based medicine; schools, medical; education, medical.
RESUMEN
La medicina basada en la evidencia es un paradigma no tan nuevo en teoría pero sí en la práctica. Su aplicación en las áreas de salud es garantía de mejora en la atención del paciente, y en los centros educativos de nivel superior fortalece la competencia de búsqueda, lectura crítica y evaluación de la evidencia ante un caso clínico por los estudiantes; a pesar de ello aún no se logra posicionar debido a que existe cierta resistencia por los que consideran más efectiva la medicina basada en la experiencia. Por lo expuesto, la presente comunicación ofrece un panorama sobre la necesidad de concientizar la eficacia de la práctica médica basada en la evidencia en los ámbitos asistencial y educativo.
DeSC: medicina; medicina basada en la evidencia; facultades de Medicina; educación médica.
Submitted: 03/07/2019
Accepted: 24/02/2020
Evidence-based medicine (EBM) or evidence-based practice (EBP) is the integration of clinical experience with the best available certainty for decision making. This implies the need to integrate the preparation and experience of the evidence-based physician, providing a more critical view to avoid errors in diagnosis, prognosis and treatment; according to Huicho et al.:(1) «... it is estimated that this need occurs five times for each hospitalized patient and twice for every three patients treated on an outpatient basis».
The EBM comprises five steps (the 5As): develop the research question; that is, translate an uncertainty into a specific question; access to the best evidence that answers the question, critically assess the selected evidence, apply the evidence in clinical practice and evaluate outcomes.(2)
It has been reported that patients who receive diagnoses, prognoses and evidence-based treatments have better outcomes than those in whom it is not done. Thus, the doctor contributes to the improvement of the quality of care, reduces mortality rates and achieves lower risks of complications; this has an effect on the efficiency of the use of resources through proposals with a balance in cost-effectiveness and a decrease in hospital stay,(3) likewise, the physician perfects his abilities to search, evaluate and apply the evidence in decision-making.(4) It is also a necessary tool for the elaboration of clinical practice guides and procedures that help in the doctor-patient relationship, and despite the important impulse offered through the proposals from various entities, its use continues as a weakness, especially in those who defend experience over evidence.(5)
The application of the EBM is a reality in several countries, and little by little it is positioning itself in those developing countries, although with problems in its practice because doctors:(6) «… need to have competences such as the bibliographic search, critical reading and evaluation of scientific articles to provide the patient with the best care according to the evidence found».
Several authors found in their study(7) that students are unaware of the existence of indexed sources of information; on the other hand, the critical reading of articles entails investing the time that many times they do not have, added to that in parallel it is necessary to evaluate if the selected evidence is of quality; this requires knowing the standards of study guides in specialized sites such as: CONSORT, STROBE, PRISMA, COREQ, STARD, SQUIRE, ENTREQ, TREND, AGREE II and GRADE.
A way to continue driving evidence-based practice, without such a sudden change, is from the classroom. The teacher should consider that the EBM contributes to the comprehensive training of students as future doctors, and that this practice develops skills similar to those that they must face during their profession; a reflective educational practice generates spaces that promote the practical use of evidence and contribute to solving clinical cases and developing scientific research.(8)
This paradigm is positioning itself with greater force because in the healthcare field it is necessary that the clinical practice guidelines follow a methodology that supports the recommendations for decision making; likewise, higher education institutions need to increase the production of their research and this is reflected through bibliometric indicators in sources such as Scopus, Scimago, Web of Science, so it is pertinent that students have the necessary skills to use them in research works, and these be disclosed by quality journals when reporting the established indicators. Thus, they are becoming aware of the need for its application at any level of patient care; in higher medical education, students are beginning to develop competencies for its subsequent application in the field of health, and although the paradigm is positioning itself, its application is an arduous but rising task.
BIBLIOGRAPHIC REFERENCES
1. Huicho L, Yhuri Carreazo N, Gonzales C. La Medicina Basada en la Evidencia: ¿mejoró la medicina que practicamos y enseñamos? Anales de la Facultad de Medicina. 2013;74(3):231-6.
2. Albarqouni L, Elessi K. Awareness, attitudes and knowledge about evidence based medicine among doctors in Gaza: a cross sectional survey. East Mediterr Health J. 2017;23(9):626-31.
3. Alva Díaz C, Aguirre Quispe W, Becerra Becerra Y, García Mostajo J, Huerta Rosario M, Huerta Rosario AC. ¿La medicina científica y el programa Medicina Basada en Evidencia han fracasado? Educ Med [Internet]. 2017 [citado 14/05/2018];19(supl.2):[aprox. 5 p.]. Disponible en: https://www.sciencedirect.com/science/article/pii/S1575181317300992
4. Abeysena C, Jayawardana P, Wickremasinghe R, Wickramasinghe U. Evidence-based medicine knowledge, attitudes, and practices among doctors in Sri Lanka. J Evid Based Med. 2010;3(2):83-7.
5. Duran-Vega HC. Cirugía basada en la evidencia. Una herramienta necesaria. Cir y Cir. 2015;83(3):265-70.
6. Urrunaga-Pastor D, Taype-Rondan A. Cursos virtuales de medicina basada en evidencias. Salud Pública Méx. 2016;58:589-91.
7. Mejía CR, Cáceres OJ, Vera CA, Nizama-Vía A, Curioso WH, Mayta-Tristán P. Uso de fuentes de información en médicos recién graduados de Lima. Rev Peruana de Medicina Experimental y Salud Pública. 2014;31(4):716-20.
8. Sánchez-Mendiola M. Educación médica basada en evidencias: ¿Ser o no ser? Investigación en Educación Médica. 2012;1(2):82-9.
Declaration of interests
The author declares no conflict of interest.
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