Evidence-based medicine training in graduate medical education: past, present and future
Evidence-based medicine training in graduate medical education: past, present and future
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DOI：
10.1046/j.1365-2753.2000.00239.x
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发表时间：
2000-05-01
影响因子：
2.4
通讯作者：
Green, ML
中科院分区：
文献类型：
--
作者：
Green, ML
循证医学（EBM）培训仍然是教育工作者面临的挑战，特别是在研究生医学教育中。在这篇文章中，我追溯了美国医学教育中循证医学的历史，回顾了传统的期刊俱乐部，并将其与独立的循证医学课程进行了对比，请愿推进综合循证医学教学，并提出了未来工作的议程。传统的期刊俱乐部不适合教授循证决策，因为它们只关注批判性评估。相比之下，循证医学课程涵盖了个体患者情境下证据的识别、评估和应用。最近一些努力的成效反映了对课程发展原则和科学严谨性的日益重视。将循证医学培训整合到住院医师已建立的临床场所提供了理论教育优势，并面临着在“实时”患者护理的要求下实践循证医学的挑战。对这一艰巨挑战的初步反应显示出希望，但其可行性和有效性仍有待探讨。对住院医师新出现的临床问题的流行病学更全面的了解，将为综合循证医学培训的持续课程开发提供信息。
Evidence-based medicine (EBM) training remains a challenge to educators, particularly in graduate medical education. In this article, I trace the history of EBM in American medical education, review traditional journal clubs and contrast them to free-standing EBM curricula, petition for the advancement of integrated EBM teaching and propose an agenda for future work. Traditional journal clubs are unsuitable to teach evidence-based decision making because of their exclusive focus on critical appraisal. In contrast, EBM curricula cover the identification, appraisal and application of evidence in the context of individual patient scenarios. The effectiveness of some recent efforts reflects increasing attention to curriculum development principles and scientific rigour. The integration of EBM training into residents' established clinical venues offers theoretical educational advantages and confronts the challenge of practising EBM under the imperatives of 'real time' patient care. Initial responses to this formidable challenge show promise, but their feasibility and effectiveness remain to be explored. A more complete understanding of the epidemiology of residents' emerging clinical questions will inform continued curriculum development in integrated EBM training.