|Year : 2019 | Volume
| Issue : 2 | Page : 33-34
Evidence-based health care: Let's embrace the good
Arti P Muley1, JD Lakhani2
1 Department of Medicine, SBKS MIRC, Sumandeep Vidyapeeth, Piparia; Sumandeep Vidyapeeth Centre for Evidence Based Education and Healthcare: A JBI Affiliated Centre, Vadodara, Gujarat, India
2 Professor, Department of Medicine. SBKS, India
|Date of Submission||19-Nov-2019|
|Date of Acceptance||22-Nov-2019|
|Date of Web Publication||02-Jan-2020|
Dr. Arti P Muley
Department of Medicine, SBKS MIRC Sumandeep Vidyapeeth Centre for Evidence Based Education and Healthcare: A JBI Affiliate Centre Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Muley AP, Lakhani J D. Evidence-based health care: Let's embrace the good. J Integr Health Sci 2019;7:33-4
Evidence-based medicine (EBM) originated in the 1990s and soon became global. It has now been accepted by all divisions of healthcare as “evidence-based healthcare (EBHC).” However, the concept is still struggling to get some ground in India Of more than 1 lakh articles on EBHC retrieved from PubMed, only 1190 were from India Of these, more than 1000 were published in the last 10 years only. Even out of these 1000, more than 700 were published in the last 5 years. Clearly, the concept has not been received well in India although it has started gaining some momentum for half a decade. The misconceptions such as “clinical experience or clinical judgment is ignored in EBM,” “it overemphasizes on blindly following the published articles,” and “it is very time-consuming” are the main reasons behind aversion to EBHC among Indian healthcare professionals.
Clinical experience has been a very important component in the clinical decision-making process since the beginning and will continue to be so, but research evidence and patients' preferences have received a variable degree of attention. “The beauty of EBHC lies in the fact that it is the integration of current best evidence with clinical experience and patients values and preferences in clinical decision-making” process. It is now greatly facilitated by the availability of evidence summaries in the form of systematic reviews and readily available critically appraised topics, thus reducing the time investment. Cochrane collaboration is a leading example, which prepares, maintains, and disseminates systematic reviews of healthcare interventions and has also made them available free of cost to educationists of many countries. Similarly, EBHC does not blindly follow the published articles but in fact teaches to critically appraise the published evidence for validity and reliability and to grade them for applicability to individual patients. It thus empowers the clinicians with ability to correctly analyze the evidence, to understand the benefit–risk–cost ratios of the interventions, and to optimize value for money for their patients. Karthikeyan and Pais published a review to correct the misconception and achieve reconciliation, though not with much change.
There is a need therefore to acquaint the clinicians with the “evidence-based” concept through activities such as workshops to remove the misconceptions. First such formal workshop was probably held as a part of the Annual Meeting of the Indian Clinical Epidemiology Network in 1995. Since then, such 3–5 days workshops are being held regularly in India at both individual and organizational levels.
However, probably, the most effective strategy to bring the evidence-based concept in habit of future clinicians would be introducing the concept from the very beginning of the training years that is at the undergraduate (UG) level. It has been adapted in a few countries but has not happened in India as the Medical Council of India and the National Board of Examination have not yet included EBM in UG or postgraduate (PG) curriculum or examinations.
Sumandeep Vidyapeeth (SV) is the only institution in India that has introduced the “evidence-based” concept for its UG as well as PG students of all constituent colleges. The UG students are sensitized with the concept and taught the basics through didactic lectures and peer teaching. They also do evidence generating short projects under guidance of faculty. One such article is a part of this issue. At PG level, evidence-based seminars and evidence-based journal clubs are conducted regularly. Bedside searching and appraising are also done as feasible to aid decision-making. Other than this, regular workshops are conducted for faculty to give hands-on experience of the evidence-based process, critical appraisal, and decision-making. The university also has provision of separate paper in UG examination on evidence-based concept which is evaluated and graded. The grades are mentioned on mark sheets to highlight the extra training they have received, which adds to their portfolio. The university also organizes the International Conference on Evidence-Based Education System “EBESCON” every 3 years. The third in this series will be held this year from December 12–14. It is a grand event which brings opportunity for people to imbibe the evidence-based concept and listen to the stalwarts of the field. The alumni of this university have given encouraging positive feedback on the whole process and activity. They reported that the training in evidence-based concept immensely helps them in decision-making for their individual patients and gives extra weightage to their qualification.
EBHC can thus, favorably, impact education and can potentially improve practice and research in healthcare if the necessary knowledge, skills, and attitudes are effectively incorporated into education programs. The European Union Evidence-Based Medicine project and evidence-based practice teaching programs for educators facilitated by Oxford (Centre for EBM) and McMaster Universities are such initiatives that provide support in advancing the evidence-based concept within healthcare education. Evidence-based education system adapted by SV is also an initiative with the same goal.
Now, it is upon us to embrace the good in EBHC to ensure that we can provide the best care to future patients and raise future healthcare professionals who are well equipped.
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