Making evidence-based content a key component in clinician education
2022年2月11日 | 4 分钟阅读
按 Takeshi Iimura
Reflections on the evolving nature of clinical knowledge and the growing need for better evidence to inform healthcare practice and decision-making.
The launch of the inaugural World Evidence-based Health Day(在新的选项卡/窗口中打开) in 2020 reflects the evolving nature of clinical knowledge and the growing need for better evidence to inform healthcare practice and decision-making.
Research and digital technology have provided ways to improve various aspects of life, including healthcare. However, with changing patient needs, heavy workloads, and barriers to up-to-date information, Japanese clinicians face the challenge of staying on top of advances in medicine.
The need to discern research-based knowledge became particularly evident during the Covid-19 pandemic. Sifting through vast amount of information worsened the already challenging nature of the roles that clinicians play in providing care to patients. Nonetheless, to improve patient outcomes, it is critical for clinicians to gain easier access to timely, high-quality, and evidence-based information.
Barriers in the application of evidence-based practice in Japan
Evidence-based medicine (EBM) must be supported by credible medical literature. Efforts to boost medical R&D in Japan were marked by the establishment of the Japan Agency for Medical Research and Development (AMED) in 2015.
The widely accepted definition of evidence-based healthcare practice is from a paper written by Dr Sackett(在新的选项卡/窗口中打开). It defined EBM as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.".
However, with vast and fast-evolving information now freely available online, it can be overwhelming for clinicians to select the right information from various sources. A recent global survey(在新的选项卡/窗口中打开) by Elsevier found that clinicians are increasingly reliant on free resources such as PubMed (56%) and Google (48%) to search for online medical information. Some also turn to sources such as Wikipedia (14%), which are not evidence-based.
Accessing evidence-based resources is time consuming and 65% of respondents in a survey agree that they lack time to access them(在新的选项卡/窗口中打开). On top of having limited time to spare due to heavy workloads, a lack of sources in their native language as well as insufficient skills and training(在新的选项卡/窗口中打开), are barriers to the use of literature for Japanese clinicians.
In the same study, while a majority of medical practitioners surveyed indicated that they read EBM sources, a mere 3% reported that they use data from EBM sources to inform their practice. Instead, in many existing medical institutions such as hospitals, personal communication with senior doctors(在新的选项卡/窗口中打开) is in contrast, driving the decision-making, which can be biased.
The issue isn’t about the understanding of the EBM, it is about, investing in R&D to help with the development of tools and technologies that will enable the implementation of evidence-based practice in the healthcare industry.
Evidence-based medicine in practice
Although EBM education has been formalized in medical school and postgraduate curricula in Japan, students and resident physicians continue to struggle practicing the principles in daily clinical settings. For EBM to be applied, it must fulfill multiple key criteria. Not only does the data have to be accurate due to the high stakes for patient care, but it also must be quickly accessed, actionable and relevant to the local context.
Some tools can be used for the intended effect. For example, Today’s Clinical Support (今日の臨床サポート) is a localized point-of-care solution in Japan. It contains hundreds of narrative reviews and easy-to-follow visual charts to support clinical decision-making for practical applications. To keep the contents locally relevant and up to date, clinical experts conduct comprehensive reviews regularly.
Leveraging on technology such as web-based platforms can also have advantages over textbooks or physical journals. Digital platforms allow easier access to information that are more regularly updated.
However, for such tools to be effective, practitioners need to be continuously trained(在新的选项卡/窗口中打开) with a strong research foundation to have the ability to manage medical information, be familiar with, and have the knowledge to use modern sources of EBM.
Technology and evidence-based content: A hybrid role
The way that clinicians use healthcare information is complex and the information they need varies. Getting the right information from the right source is increasingly critical. The prevalence of digital technology such as telemedicine is also changing the way patient care is being delivered and how clinical knowledge is being accessed.
However, more work needs to be done for a robust adoption of digital technology in the context of Japanese healthcare systems, with evidence-based training playing a critical role in this transformation. Not only is this strategic push able to ensure the quality of clinician education and knowledge, but ultimately, it may be a necessary step to boost quality of care, patient outcomes and minimize medical errors.