Background:
Evidence-based
medicine (EBM) has always required integration of patient values with ‘best’
clinical evidence. It is widely recognized that scientific practices and
discoveries, including those of EBM, are value-laden. But to date, the science
of EBM has focused primarily on methods for reducing bias in the evidence,
while the role of values in the different aspects of the EBM process has been
almost completely ignored.
Discussion:
In this
paper, we address this gap by demonstrating how a consideration of values can
enhance every aspect of EBM, including: prioritizing which tests and treatments
to investigate, selecting research designs and methods, assessing effectiveness
and efficiency, supporting patient choice and taking account of the limited
time and resources available to busy clinicians. Since values are integral to
the practice of EBM, it follows that the highest standards of EBM require
values to be made explicit, systematically explored, and integrated into
decision making. Summary: Through ‘values based’ approaches, EBM’s connection to the humanitarian principles upon which it was founded will be strengthened.
Pearce W, Raman S,
Turner A. Randomised trials in context: practical problems and social aspects
of evidence-based medicine and policy. Trials 2015, 16:394
doi:10.1186/s13063-015-0917-5
ABSTRACT
Randomised
trials can provide excellent evidence of treatment benefit in medicine. Over
the last 50 years, they have been cemented in the regulatory requirements
for the approval of new treatments. Randomised trials make up a large and
seemingly high-quality proportion of the medical evidence-base. However, it has
also been acknowledged that a distorted evidence-base places a severe
limitation on the practice of evidence-based medicine (EBM). We describe four
important ways in which the evidence from randomised trials is limited or
partial: the problem of applying results, the problem of bias in the conduct of
randomised trials, the problem of conducting the wrong trials and the problem
of conducting the right trials the wrong way. These problems are not intrinsic
to the method of randomised trials or the EBM philosophy of evidence;
nevertheless, they are genuine problems that undermine the evidence that
randomised trials provide for decision-making and therefore undermine EBM in
practice. Finally, we discuss the social dimensions of these problems and how
they highlight the indispensable role of judgement when generating and using
evidence for medicine. This is the paradox of randomised trial evidence: the
trials open up expert judgment to scrutiny, but this scrutiny in turn requires
further expertise.
Tsakitzidis G,
Timmermans O, Callewaert N, Truijen S, Meulmans H, Van Royen P. Participant
evaluation of an education module on interprofessional collaboration for
students in healthcare studies. BMC Medical Education 2015, 15:188
doi:10.1186/s12909-015-0477-0
ABSTRACT
Background:
Interprofessional
collaboration is considered a key-factor to deliver the highest quality of
care. Interprofessional collaboration (IPC) assumes a model of working
together, in particular with awareness of the process of interprofessional
collaboration, to develop an integrated and cohesive answer to the needs of the
client/family/population. Educational modules are developed in response to a
perceived need to improve interprofessional collaboration for the benefit of
patientcare. Up until 2005 no explicit module on interprofessional
collaboration existed in the education programs of the Antwerp University
Association (AUHA). During a decade the ‘Interprofessional Collaboration In
Healthcare (IPCIHC) – module’ is organised and evaluated by its participants.
Methods: One group,
post-test design was used to gather data from the participating students using
a structured questionnaire. Data was collected between March 2005 and March
2014 from participating final year students in healthcare educational programs.
Results: 3568
(84 % overall response) students evaluated the IPCIHC module from 2005 up
to 2014. Over 80 % of the participants were convinced the IPCIHC increased
their knowledge and changed their understanding that it will impact their
future professional relationships, and felt a greater understanding about
problem-solving in healthcare teams. Even though the results indicate that the
goals of the IPCIHC module were achieved, less than 60 % of the
participants experienced a change in attitude towards other professional
groups.
Conclusions:
Despite the
positive outcomes from the participants, the challenge still remains to keep on
educating future healthcare providers in interprofessional collaboration in
order to achieve an increase in interprofessional behaviour towards other
professional groups. Research is needed to investigate the effectiveness of
undergraduate programs on the quality and safety of patientcare in practice.
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