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How to teach Evidence Based Medicine

Alejandro Piscoya, MD

Alejandro Piscoya, MD
Professor of Medicine - Universidad Peruana de Ciencias Aplicadas (UPC)
Gastroenterologist – Hospital Nacional Cayetano Heredia, Lima - Perú
Member of the Editorial Board – Revista de Gastroenterología del Perú

Evidence Based Medicine (EBM) provides a set of tools that can be quite important as one gets to work and study at the same time. When studying for a specialty one needs to read so much that an approach to improve reading and understanding of papers becomes crucial. EBM can help you to find, for example systematic reviews, i.e. short articles other people have written to put together the evidence from many original articles and this can save a substantial amount of time.

EBM is important also for the WGO and from time to time EBM is taught in their training centers like the one in Bolivia (La Paz Training Center) 1 where some formal training in EBM was provided in their short course. I remember there were two doctors from Uruguay that taught us the way to read a paper and realize whether it will be useful for us. Last year they gave us the opportunity to participate in another EBM workshop. The way EBM is taught is somewhat different from other learning activities. Here we did not sit in our chairs listening to a  lecturer. Instead, we had to read the paper in advance and work in small groups solving questions about the paper and later sharing our answers with everybody else and discussing the results. The Center of Evidence Based Medicine of the University of Oxford has a “How to teach EBM” Workshop 2 where EBM is taught nearly in the same way as in La Paz.

One of the most interesting courses of the WGO is the “Train the Trainers” (TTT) 3. TTT is an outstanding experience both as a student and as a faculty member. It is organized in small work groups in mornings and afternoons with very few lectures but many sessions where  participants can discuss and obtain a better understanding of what was just taught. One of the topics at TTT is EBM, which is taught in small groups with critical appraisal of several papers.

Right after my TTT course in Santiago 2009, I found a group in my former university that was teaching EBM. I joined them and we have worked together since then. This was an international collaboration that by the time I started working with them was funded by ICOHRTA 4, whose focus was HIV and Tuberculosis but not gastroenterology. This was a challenge but the way EBM is taught can be used in any specialty so I managed to keep learning while working with them as a facilitator. Last year, after our “hands-on training”, the Peruvian faculty took over most of the lectures and workshops of the course. By then, the team was really interested in the assessment of the whole course, but we found there was not much information about the impact of our work. After gathering information from a questionnaire that had been answered by the participants during the last 5 years, we realized how difficult it was to use these questionnaires. The most interesting conclusion of our research was that most of the tools were written in English. Since English is not our mother tongue, it was difficult for our students to understand some aspects of EBM and it will probably continue to be difficult without a proper translation of the course material into Spanish. Another important issue was the number of days of the workshops and the time that the students had available. Most of the students had clinical work to do and prioritized their jobs and could not stay at the workshop for an entire day. Finally, we need better instruments for assessing our results 5.

Some of these difficulties were shared during the last TTT workshops that were organized by the WGO; first in Santiago de Chile in 2009, a group of the non-English speaking participants had difficulty understanding the lectures and more trouble during critical appraisal and how to teach endoscopy workshops. Last year in Lima, Peru, the faculty faced the same problems again and part of the workshops therefore were  changed in order to use mother tongue (Spanish) of most of the participants who were divided between a Spanish-speaking and an English-speaking groups. This was quickly addressed by the WGO and this year we will have our first WGO sponsored TTT in Spanish that will be held in August in Porto Alegre, Brazil 6.

Funding is always an issue and that is why the ICOHRTA has been of such great help in our Peruvian workshop. The WGO recognized this from the beginning and fortunately WGO manages to fund most if not all costs of their workshops, an effort that is appreciated worldwide.

The issue of having an instrument to assess the results of the workshop has recently been addressed by a Spanish group 7. They have  validated a Spanish translation of the Fresno test, and we may try to use it in our next workshops. We expect some difficulty since Latin  American people differ from Europeans, and we may need to adapt part of the questions but the Fresno test is still a validated instrument that should be of great help. I believe that we can also use this questionnaire as the basis to create our own TTT assessment questionnaire.

This is our call for action; WGO should evaluate the short and long-term benefits of their current training courses and especially the TTT courses, both in the English version and in the new Spanish version. There is an instrument available for EBM assessment; it can be used as a model in order to develop methods to assess our courses individually and as a whole.

References

  1. La Paz WGO Training Center. Available at: http://www.lapaztrainingcenter.org/.
  2. Oxford University. Center of Evidence Based Medicine. Available at: http://www.cebm.net/.
  3. World Gastroenterology Organization (WGO). Train the Trainers. Available at: http://www.worldgastroenterology.org/train-the-trainers.html.
  4. International Clinical, Operational, and Health Services Research and Training Award (ICOHRTA). Available at: http://www.fic.nih.gov/programs/training_grants/icohrta/index.htm.
  5. Tomatis C, Taramona C, Rizo-Patrón E, Hernández F, Rodríguez P, Piscoya A, Gonzales E, Gotuzzo E, Heudebert G, Centor RM, Estrada CA. Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships. J Eval Clin Pract 2011 (first online Jan 30, 2011, http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2011.01635.x/full).
  6. WGO. Spanish TTT. Available at: http://www.worldgastroenterology.org/train-thetrainers-workshops-2011.html.
  7. Argimon-Pallàs J, Flores-Mateo G, Jiménez-Villa J, Pujol-Ribera E. Psychometric properties of a test in evidence based practice: the Spanish version of the Fresno test. BMC Medical Education 2010;10(1):45.