Kamalbekova G, Kalieva M
JSC "Astana Medical University", Research and Education Center of Evidence-Based Medicine, Astana, Republic of Kazakhstan.
Kazakh National Medical University named after SD Asfendiyarov, Clinical pharmacology and Pharmacotherapy Department, Almaty, Republic of Kazakhstan.
Int J Risk Saf Med. 2015;27 Suppl 1:S95-6. doi: 10.3233/JRS-150705.
Understanding principles of evidence-based medicine is of vital importance for improving quality of care, promoting public health and health system development. Understanding principles of evidence-based medicine allows using the most powerful information source, which have ever existed in medicine.
To evaluate the effectiveness of teaching Evidence-Based Medicine, including long-term outcomes of training.
The study was conducted at the Medical University of Astana, where the Scientific and Educational Center of Evidence-Based Medicine was established in 2010 with the help of the corresponding project of the World Bank. The participants of the study were the faculty trained in Evidence-Based Medicine at the workshop "Introduction to Evidence-Based Medicine" for the period of 2010-2015 years. There were a total of 16 workshops during the period, and 323 employees were trained. All participants were asked to complete our questionnaire two times: before the training - pre-training (to determine the initial level of a listener) and after the training - post-training (to determine the acquired level and get the feedback). Questionnaires were prepared in such a way, that the majority of questions before and after training were identical. Thus, it provided a clear picture of the effectiveness of training. Questions in the survey were open-ended so that the respondents had the opportunity to freely and fully express their views. The main part of the questionnaires included the following questions: "Do you understand what evidence-based medicine is", "how do you understand what the study design means", "what is randomization", "how research is classified", "do you know the steps of decision-making according to Evidence-Based Medicine, list them", "what literature do you prefer to use when searching for information (print, electronic, etc.)", "what resources on the Internet do you prefer to use".
Only 30-35% of respondents gave correct answers to the questions on understanding EBM, understanding study designs, randomization. There were no correct or complete answers to the question on study classification. Again, 35% of respondents provided correct answer to the question about the stages of decision-making process from the perspective of EBM, 65% - provided no answer. One fourth (25%) of the respondents preferred using printed literature. Only very few respondents indicated Cochrane Library, Medline (PubMed), Tripdatabasa as preferred Internet sources of information, with 40% indicating Google and 60% - other sources.The results of post-training survey showed that nearly 90% of the respondents gave correct answers to all the questions.With the aim to identify knowledge survival (the long-term training outcomes) we conducted the third survey in May 2014 in previously trained people at the seminar "Introduction to Evidence-Based Medicine". The respondents were asked to answer 4 questions, and to assess previously obtained information on the basics of Evidence-Based Medicine on a 10-point scale.We found that 100% of the respondents answered «Yes» to the question: «Have you changed your behavior after the seminar?» To the question: «Have you encountered difficulties in implementing the principles of evidence-based medicine in the educational process?» 56% of the respondents answered that they had not encountered any difficulties. The other 44% faced the difficulties associated with implementation of Evidence-Based Medicine: lack of understanding by students, low knowledge survival rate among students, too many questions from the students, difficult disputes and discussions.To the question: «Have you encountered difficulties in implementing the principles of Evidence-Based Medicine in practical health-care?» only 37.5% of the respondents answered that they had not encountered difficulties. But the remaining 62.5% of the respondents faced the problems and difficulties in implementing the principles of evidence-based medicine in their practice. These were: failure in implementing, lack of understanding on the part of colleagues, commitment to traditional obsolete methods of treatment, discrepancy between some of the existing standards of diagnosis and treatment and principles of evidence-based medicine.To the question: «Are there any end products after listening to the seminar?» 67% of the respondents answered in affirmative. The end products were mainly marked by the publication of articles and abstracts, including international publications, and participation in the working group on the revision and development of clinical protocols.
Barriers to implementation of Evidence-Based Medicine in education and practice are lack of funding to provide access to reliable sources of information, websites; outdated research methodology skills in medical education, lack of skills in critical evaluation of medical information; tradition of authoritarian relationships, use of past experience stencils; failure to comply with continuing education programs ("from training to professional development"). Knowledge of Evidence-Based Medicine, skills to perform searches for scientific data, to evaluate their validity and to transform scientific data into practical solutions are necessary for health workers in their daily activities. This culture needs to be rooted in modern medical education.
理解循证医学原则对于提高医疗质量、促进公共卫生和卫生系统发展至关重要。理解循证医学原则有助于利用医学领域有史以来最强大的信息来源。
评估循证医学教学的效果，包括培训的长期成果。
该研究在阿斯塔纳医科大学进行，2010年在世界银行相应项目的帮助下，循证医学科学教育中心在此成立。研究参与者是在2010 - 2015年期间参加“循证医学导论”讲习班接受循证医学培训的教员。在此期间共举办了16期讲习班，培训了323名员工。所有参与者被要求填写两次我们的问卷：培训前——预培训（以确定听众的初始水平）和培训后——后培训（以确定所学水平并获得反馈）。问卷的设计方式是，培训前后的大多数问题相同。这样就能清楚地了解培训效果。调查问卷中的问题为开放式，以便受访者有机会自由充分地表达他们的观点。问卷的主要部分包括以下问题：“你是否理解循证医学是什么”，“你如何理解研究设计的含义”，“什么是随机化”，“研究如何分类”，“你是否知道循证医学的决策步骤，列出它们”，“你在搜索信息时更喜欢使用什么文献（印刷品、电子文献等）”，“你更喜欢使用互联网上的哪些资源”。
只有30% - 35%的受访者对关于理解循证医学、理解研究设计、随机化的问题给出了正确答案。关于研究分类的问题没有正确或完整的答案。同样，35%的受访者从循证医学的角度对决策过程的阶段问题给出了正确答案，65%的人未作答。四分之一（25%）的受访者更喜欢使用印刷文献。只有极少数受访者表示Cochrane图书馆、Medline（PubMed）、Tripdatabasa是首选的互联网信息来源，40%的人表示是谷歌，60%的人表示是其他来源。培训后调查的结果显示，近90%的受访者对所有问题都给出了正确答案。为了确定知识留存情况（培训的长期成果），我们于201年5月对之前在“循证医学导论”研讨会上接受培训的人员进行了第三次调查。要求受访者回答4个问题，并以10分制评估之前获得的关于循证医学基础知识的信息。我们发现，100%的受访者对“研讨会后你是否改变了你的行为？”这个问题回答“是”。对于“你在教育过程中实施循证医学原则时遇到困难了吗？”这个问题，56%的受访者回答他们没有遇到任何困难。另外44%的人面临与实施循证医学相关的困难：学生理解不足、学生知识留存率低、学生问题过多、艰难的争论和讨论。对于“你在实际医疗保健中实施循证医学原则时遇到困难了吗？”这个问题，只有37.5%的受访者回答他们没有遇到困难。但其余62.5% 的受访者在实践中实施循证医学原则时面临问题和困难。这些问题包括：实施失败、同事理解不足、坚持传统过时的治疗方法、一些现有诊断和治疗标准与循证医学原则不符。对于“听完研讨会后有任何最终成果吗？”这个问题，67%的受访者给出了肯定回答。最终成果主要表现为文章和摘要的发表，包括国际出版物，以及参与临床诊疗规范修订和制定的工作组。
循证医学在教育和实践中的实施障碍包括：缺乏资金以获取可靠的信息来源、网站；医学教育中过时的研究方法技能，缺乏对医学信息进行批判性评估的技能；权威关系传统、使用过去经验模板；未遵守继续教育计划（“从培训到专业发展”）。循证医学知识、进行科学数据搜索、评估其有效性并将科学数据转化为实际解决方案的技能，是卫生工作者日常活动所必需的。这种文化需要在现代医学教育中扎根。
