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Evidence Pyramid


Shurtz et al. recently published “Teaching Evidence-based Veterinary Medicine in the U.S. and Canada” in the Journal of Veterinary Medical Education.

The authors reported on their survey of faculty and librarians of 22 out of 35 of the North American veterinary colleges. An average of 4 representatives of each institution responded to questions about where and how they taught evidence-based veterinary medicine (EBVM) in their curricula. They reported that the most common skill taught was literature searching (61%), followed by applying evidence to patient care (48%), critically appraising the literature (40%), formulating a clinical question (38%), and assessment of success of clinical application of evidence (19%). Most of the skills were taught in didactic clinical courses, with the exception of critical appraisal, which was generally taught in basic science courses.

The top 3 information resources they taught and/or students used were PubMed/MEDLINE (96%), CAB Abstracts (42%), and Veterinary Information Network (41%). Surprisingly, librarians were engaged in the instruction only 41% of the time.

The article also asked instructors about the challenges they faced in implementing EBVM instruction. Key problems mentioned were:
1. Students were resistant to use the literature to answer clinical questions.
2. Students often felt that the answers should be provided to them by instructors, not obtained following a search.
3. Faculty and students saw that faculty didn’t often overtly practice EBVM, “relying on their own clinical experiences and expert opinion rather than research-based information.”
4. Students often searched Google and VIN steering toward findings not necessarily focused upon research results.
5. Faculty were resistant to assigning students literature searches on clinical rotations.
6. Faculty just didn’t see that there was enough time for EBVM in the curriculum as it competed with primary content instruction.

Perhaps one quote provided by a survey respondent summarizes the real challenge:
‘‘The veterinary curriculum is overfull. . . . Having too much material to commit to memory leaves little time for students to focus on the critical role of research in advancing clinical practice.’’

So, it appears that most veterinary medical curricula still hold “content as king.” Shouldn’t we be looking for ways to put process such as critical thinking and evaluation of current evidence a bit higher on priority list? Content and knowledge evolve…the practice we might give our students during their training on application of information WILL transfer 5-10 years into the future. Much of the content we assiduously lecture to them about, will NOT.

The above image is based on the EBM Page Generator (2006) from Dartmouth College and Yale University and the Coursera MOOC “Understanding Clinical Research: Behind the Statistics“ (2016)