Should We Be Teaching Information Management Instead of Evidence-based Medicine?

Abstract

To encourage high-quality patient care guided by the best evidence, many medical schools and residencies are teaching techniques for critically evaluating the medical literature. While a large step forward in many regards, these skills of evidence-based medicine are necessary but not sufficient for the practice of contemporary medicine and surgery. Incorporating the best evidence into the real world of busy clinical practice requires the applied science of information management. Clinicians must learn the techniques and skills to focus on finding, evaluating, and using information at the point of care. This information must be both relevant to themselves and their patients and be valid. WHERE ARE WE NOW?: Today, orthopaedic surgery is in the post-Flexner era of passive didactic learning combined with the practical experience of surgery as taught by supervising experts. The medical student and house officer fill their memory with mountains of facts and classic references 'just in case' that information is needed. With libraries and now internet repositories of orthopaedic information, all orthopaedic knowledge can be readily accessed without having to store much in one's memory. Evidence is often trumped by the opinion of a teacher or expert in the field. WHERE DO WE NEED TO GO?: To improve the quality of orthopaedic surgery there should be application of the best evidence, changing practice where needed when evidence is available. To apply evidence, the evidence has to find a way into practice without the long pipeline of change that now exists. Evidence should trump opinion and unfounded practices. HOW DO WE GET THERE?: To create a curriculum and learning space for information management requires effort on the part of medical schools, residency programs and health systems. Internet sources need to be created that have the readily available evidence-based answers to patient issues so surgeons do not need to spend all the time necessary to research the questions on their own. Information management is built on a platform created by EBM but saves the surgeon time and improves accuracy by having experts validate the evidence and make it easily available.

Teaching evidence-based medicine application: transformative concepts of information mastery that foster evidence-informed decision-making

“…Trusted, high-quality information-gathering services should be used instead of attempting to read original research literature : The skills needed for the classic EBM approach of acquiring original research, assessing it for validity and applying the results are less relevant now that there are robust literature survey services that do this work and provide short, accessible summaries 13 28. A participant explains:…”

Veterinarian barriers to knowledge translation (KT) within the context of swine infectious disease research: an international survey of swine veterinarians

“…Alternatively, others recommend instead greater emphasis on teaching skills for information management over teaching traditional EBM skills [ 33 , 34 ]. The rationale is that skill to quickly identify sources of relevant, synthesized, and contextualized information is highly advantageous in time constrained environments and more conducive to rapid end-user uptake of the best available research [ 5 , 33 , 34 ]. Importantly, however, the caveat is that robust and applicable syntheses are also readily accessible [ 5 , 11 , 34 , 77 ].…”

The role of clinical evidence in emergent therapies: an empirical study on femoropopliteal stent‐angioplasty in Europe

“…Previous research has revealed the role of clinical evidence to be limited through other factors in clinical practice. These factors included lack of resources, lack of time, inadequate skills and inadequate access to find, evaluate and use published clinical evidence at the point of care [28–30]. Other limiting factors comprised individual patient complexity, personal practice, clinical experience, opinions of colleagues, pathophysiologic rationale, goals and values of patients and other stakeholders, health care system features and a general reservation towards published clinical evidence, due to the influence of experts and editors along the publication process [4–7].…”