Have you recently needed to recite the dates of King Tut’s rule? Nope. Not necessary. Finding information at the point of care? Knowing how healthcare systems work? Necessary. We learn so many things that we never need. Evidence based medicine (EBM) is so important and our time with students so limited, that we must teach the most clinically relevant EBM topics. Take (or leave, really) the pyramid of evidence for example.
What do you do most in clinic? Critically appraise one article at a time and then compare it to others of varying levels of the pyramid in between patients for each clinical question you have? Again, nope. I’m not even going to include a schematic of the angular image in question. If you’re reading this, there’s a good chance you can draw the research study methodology pyramid from memory. There’s also a good chance that you only use that knowledge when teaching EBM and when yelling at the latest “a new study shows” news clip. Then why do we teach that this as fundamental to the way to realistically practice EBM? Most of us actually go to secondary, trusted sources for point-of-care answers if we even take the time to look something up.
Let’s have students practice with these more, know their strengths and limits.
(These guys helped you at the point of care recently?)
EBM is best learned when demonstrated and so we need students to have more facility with electronic pre-appraised databases and more standardised patient encounters before they reach the clinic floor. Students do need to know that not all medical information is the same, but so much more. Stop making them calculate sensitivity and specificity. Use the time to teach what those terms mean and that a positive test doesn’t always mean a disease is present.
(Actual footage of an ancient Egyptian saying ‘No, thank you’ to calculating biostats.)
We also need more focus on how we communicate evidence and on using more visuals. We’re seemingly horrible at explaining risk to ourselves and our patients. (See Dylan Collins (@DylanRJCollins) and Stefania Marcoli’s (@stefina) work on a cardiovascular risk communication toolkit and on communicating risk and “Getting Risk Right: Understanding the Science of Elusive Health Risks” by Geoffrey Kabat for more). We need to get comfortable with how to use social media as an academic tool.
(Twitter: The academic clinician’s new papyrus)
Let’s move the ancient study pyramid, well, down the pyramid of teaching priority and move how we teach EBM into modern times. I call for EBM courses focused on applicable, clinical medical information skills, lest we continue to train students in theory and then have them re-learn “how it works in real life”. We need evidence based teaching and more information mastery.
I urge you to look at your own EBM curriculum and eliminate anything from the rule of King Tut. Teach to the needs of the future clinician, not to the needs of how it has always been done. Stop being a Luddite, we aren’t using papyrus anymore.
Assistant Clinical Professor,