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Evidence, expertise and patient: useful practical ideas on teaching EBM in the workplace

Blog entry written on: Educational strategies to enhance EBM teaching and learning in the workplace: a focus group study, (bmjebm-2020-111383.R1)

Authors: L.S. Welink, E. de Groot, R.A.M.J. Damoiseaux, M.E.L. Bartelink 

If physicians want to practise evidence-based medicine (EBM) when making decisions for individual patients, it is essential to learn how to combine the three circles of EBM: the best available evidence with their own clinical expertise and the patient’s values and preferences. However, practising EBM is a complex task and difficult to learn. We do know that integration of teaching in clinical practice will help students to be able to actually use EBM. We asked groups of supervisors and trainees in general practice to share as many as possible practical ideas of how to integrate evidence in daily teaching practice. We listed learning opportunities in daily learning conversations, in observations and in other supervision moments in the workplace. An example of suggested learning opportunities was to observe each other’s consultations, with a very structured debriefing after observation, including all three EBM circles. Journal clubs with consequent discussions on how to implement in own practice and searching for evidence-on-the-spot during learning conversations were mentioned as well. As was the suggestion to prepare education for colleagues together (supervisor and trainee), always a good way to learn yourself.

In the words of a supervisor: So, we both shoot videos of our consultations and watch them together. Then I thought it might be nice to think up a theme in advance (…) and go into the meeting with my ‘theme glasses’ on, so to speak. Then, we ask each other critical questions, like what was on your mind when you made that decision, which resources did you use? (…) And if you deviate from the standard, what was the argumentation?”

And another suggestion: “So, if you do consultations together, you agree to always round off in a certain way. For example, (by saying to the patient) well, your request for help was this and that, and on my search, I found this and that, and well… the good protocol for this is (or) according to the guidelines it’s this and I’ve also had good experience with this or that. So, you make why you are doing something very transparent, from the patient’s circle as well.”

With some inspiration from supervisors and trainees, you might thus be able to pay more attention to the last steps in teaching EBM, as proposed in the Sicily Statement, beyond ask, acquire and appraise to where it really involves the patient, in the final steps of apply and assess.

The present study summarizes practical ideas from experienced supervisors and trainees. Other research from our group focusses on how exactly trainees and supervisors can learn EBM in clinical practice during observation of each others consultations and in learning conversations. Future research will hopefully also shed more light on the integration of shared decision making into these final steps of EBM.

Doctor and patient


Author thumbnail

Marie-Louise (M.E.L.) Bartelink, MD PhD

Julius Center, University Medical Center Utrecht, The Netherlands

COI: Nothing to declare


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