Evidence Based Medicine practice in IM residency?

[Santiago]

Hi everyone,

I am in a small community based program where EBM is talked about a lot but never practiced.

I have heard that lots of university based program put much emphasis on it. Recently, one of my coresidents ran into an IM resident from Mayo Clinic who also said that they routinely practice EBM in their everyday patient care.

Is it true? Or Mayo is an exception?

What about residents in other big university programs?

Could some one share the experience of using EBM in their residency training?

Thanks.

---

Members don't see this ad.

 

[in4mthsMD]

are u kidding me? EBM is the norm these days at almost any reputable institution. I will highly suggest for anyone to ONLY CONSIDER those programs that showed that during the interview day. It's vital to our survival as proficient physicians. Remember, that is why we call it practicing medicine. I have seen some community programs like York Hospital, Lennox Hill, Washington Hospital do a superb job in having consistent discussions about the latest EBM literature and guidelines. I only wonder what could be going on at your hospital. Maybe, you need to initiate it. Good luck, and hopefully you won't piss off some of your colleagues, the lazy ones of course!

 

[Santiago]

are u kidding me? EBM is the norm these days at almost any reputable institution. I will highly suggest for anyone to ONLY CONSIDER those programs that showed that during the interview day. It's vital to our survival as proficient physicians. Remember, that is why we call it practicing medicine. I have seen some community programs like York Hospital, Lennox Hill, Washington Hospital do a superb job in having consistent discussions about the latest EBM literature and guidelines. I only wonder what could be going on at your hospital. Maybe, you need to initiate it. Good luck, and hopefully you won't piss off some of your colleagues, the lazy ones of course!

Any residents here????

 

[lurkerboy]

Any residents here????

we use it in all patient care. your attendings should at least listen to you if what you want to do is backed up by ebm! pull the references for them and put them in the charts ;-)

 

[doc05]

yes, but is there any evidence that EBM works?

 

[Fantasy Sports]

EBM is fantastic. What is becoming even more the norm is for big academic hospitals to start keeping track of ALL patients and seeing the treatment outcomes. So basically you can go to any computer terminal, input parameters, and generate an outcomes matrix that you can make the decision on.

EBM is the present and future of allopathic medicine, and on top of that, it will make frivilous lawsuits harder to litigate sucessfully since all you need to do is show the data to indicate the basis of your decision.

It is definitely going to be a huge factor in the way we practice medicine, especially as hospitals switch over to completely electronic systems.

 

[Santiago]

I completely agree with above response...

Would you guys also mentions that what are the differenct resources for EBM being used frequently, AND how comfortable you are in criticaly appraising an article.

 

[cytoskelement]

Although I agree that EBM is very important, I'm not sure if it accounts for "outliers". Although therapy supported by EBM will be beneficial for most patients, it may not provide the best care for "ALL" patients. I feel that it will be easy to hide behind EBM when treatment plans fail. There are many examples of non-EBM treatments that are very beneficial (eg. off-label Rx, manipulations, etc.) that are difficult to provide supportive data (whether it's just not feasible or will be lengthy due to trials, etc.) As an aside, I am reminded of the article published by the British Medical Journal...

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials.

It has never been shown by a randomized trial that jumping out of an airplane with a parachute is better than without... although observational data sure support it.

 

[Trajan]

EBM is fantastic for insurance companies, researchers, government agencies, and academics. However, I'm not sure if I'd want my own doctor to be some wonk who thinks of everything pertaining to medical care in terms of EBM (there are some out there who do).

The BMJ example is perfect. Another from my own experience is a med-peds doc (and EBM guru) who lectured us on EBM and pointed to a study that had inconclusive results regarding the health risk of ecstasy use in teenagers. He stated that if a teen came in to your office and confessed to trying or thinking about trying ecstasy, telling him or her that ecstasy could kill you or do horrible things would amount to lying and propaganda. No joke.

This is what gets me about EBM -- when taken to an extreme it drains physicians of whatever common sense they have (and the more I see, the more I'm convinced that medicine is full of wonks lacking any common sense).

 

[uxbridge]

This is what gets me about EBM -- when taken to an extreme it drains physicians of whatever common sense they have (and the more I see, the more I'm convinced that medicine is full of wonks lacking any common sense).

EBM isn't just about believing what you read in a journal - it's about appraising it, critizing it and challenging it's credibility. That's EBM. And yes, EBM is of great importance in our era - the fundamentals of most protocols are based on EBMs. With regards to EBM theories not being applicable to certain patients, well, that is EXACTLY one of the points in appraising an article before applying it! "Does the patient population reflect my patient?"

Regarding how strongly a program applies EBM, the ideas given were great. Another way is to see how active their journal clubs are, etc.