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Current challenges in Evidence based Medical Education and the way forward

This presentation explores the challenges in evidence-based medical education (EBME) and proposes solutions for moving forward. Topics include the integration of faith-based medicine (FBM) and market-based medicine (MBM), the role of informal medical education, and the need for integrating population data with patient values. The presentation also discusses the limitations of traditional medical curricula and the rise of EBME.

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Current challenges in Evidence based Medical Education and the way forward

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  1. Current challenges in Evidence based Medical Education and the way forward Rakesh Biswas Dept of Medicine, IQ city Medical College Hospital, Durgapur, India

  2. Presentation Objectives: Introduce a spin on Medicine (FBM, MBM), Evidence (EBM), Education (Developing the problem statement) 7.5 minutes Identify: Challenges (Problem statement key) & Way forward (solutions) 7.5 minutes with Q & A 5 minutes

  3. Tale SpinOnce upon a time, long-long ago, in a forest not so far away...

  4. Taste/Test of Faith based Medicine?

  5. “The soul of medicine is easy to understand. You master the microcosm, the macrocosm and in the end let things happen as it pleases God.”Mephistopheles in Faust

  6. Monetizing Faith: Market based Medicine

  7. Once upon a time, long-long ago, in a medical college not so far away...

  8. Formal Medical Education: A faithful instrument of the Market?

  9. Informal Medical Education: A faithful instrument for the patient? “... he noticed a ‘pea-sized lump’ on the roof of his mouth. A local GP dismissed it as a reaction to a fish-bone, but having borrowed textbooks from a medical student in the next room, he self-diagnosed a squamous-cell carcinoma. ”

  10. Informal Medical Education: A faithful instrument for the patient? “... it took him months to arrange a biopsy at Chittaranjan Cancer Hospital; the pathology confirmed his diagnosis. Knowing he had received a death sentence, Sen and his family pushed for what was then, in India, a new form of treatment: radiotherapy.”  Quoted from Paul Farmer: http://www.lrb.co.uk/v37/n03/paul-farmer/who-lives-and-who-dies

  11. MCQ time: Who is the prime beneficiary of Medical education? Student Faculty Patient Practitioner

  12. Role of the primary beneficiary of medical education in the rise of EBME... • Patients/humans at the receiving end lose faith at times and challenge FBM • Patients/humans at the receiving end lose money and challenge MBM

  13. Game Changer? Question Efficacy, Demand Evidence

  14. What is evidence based medicine? "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, 1996) “Evidence based Medicine is the integration of the bestresearch evidence with clinical expertise and patient values" (Sackett, et al. 2000)

  15. What is Evidence based Medical Education? • Education to produce a ‘person’ who can practice Evidence based Medicine (i e integrate evidence, expertise and values) • Evidence of efficacy of various teaching methods while delivering medical education? x

  16. Challenges in EBME: Integrating two different Learning paradigms? Population Data Patient Values Exploratory Implicit Contextual. Individualized: applicable to specific problem instances • Explanatory • Explicit • Non Contextual. • Generalized: applicable to generic problems BMC Medical Informatics and Decision Making 2004, 4:19 http://www.biomedcentral.com/1472-6947/4/19

  17. EBME Challenges Listed: • FBM • MBM • Integrating Population data to Patient Values • Traditional Medical curricula and limitations of current medical knowledge and evidence

  18. Traditional Medical curricula • Based on rote memorization of arcane facts • No emphasis on developing skills to solve real patient problems • No integration between education and practice

  19. Traditional Medical Education to Evidence based medical education: How do we/did we change the game?

  20. Medical Education’s Bloom Game • Level 1: R emember • Level 2: U nderstand • Level 3: A pply • Level 4: A nalyse • Level 5: E valuate • Level 6: C reate

  21. Patient centred problem based learning and the rise of EBME? • EBME was a game changer in medical education • Traditional medical education was a level 1 and 2 game • EBME brought in level 3, 4, 5 with a promise of 6.

  22. EBME: The Way forward? In Thought MBME EBME PBME FBME

  23. EBME: The Way forward? In Thought Inspire faith in evidence and market transparency & accountability toward quality improvement?

  24. The Way forward in Action: EBVs?

  25. The Way forward? Action • Implementing EBME at • Policy level Inoculate the health system with EBVs and EBVEs (products of EBME) • Curricular level Create a Patient centred EBVE driven ecosystem

  26. Curricular Way forward: A school for EBVEs?

  27. EBME: Bedside Bloom Game • Symptoms and Signs (Data capture and Pattern recognition Level 3) • Health Information Processing (Level 4 and 5 but you will also need to look up Level 1 and 2) • Level 6: Evidence based Innovation

  28. Broad Learning goal At the end of this course you are expected to become a Medical Detective (MD) and not only achieve competency in clinical problem detection but also become proficient in gathering and adding online ‘evidence based solutions’ toward individual patients

  29. EBME Way forward: Global learning toward Local Caring

  30. Blended Learning: Offline data collection and online processing Patient Values Expertise Evidence

  31. Blended Learning: Offline data collection and online processing Patient Values Expertise Evidence

  32. EBME Blended learning By-product

  33. Way forward in policy: An ecosystem for EBVE Enter: Trained EBVEs Role: Create informational awareness in the community both among patients and doctors Serve as effective 'clinical-auditors' and instil error-check mechanisms to benefit both doctors and patients.

  34. Village healer unlicenced Patient’s Wife and family Experienced Global physician Patient Primary doctor at the rural PHC Community health worker CHW Evidence based Value Educator EBVE Physicians and medical students in Urban India ANM at the village PHC

  35. So what? Strengths Weaknesses Opportunities Threats

  36. Strengths and Opportunities Generation of new employment in the community. Transition of workload from ?over-tasked physicians? to community based EBVEs Exposure for students and professionals to unique cases; and innovative, interdisciplinary health solutions.

  37. Strengths and Opportunities • Expansion of this ‘ecosystem’ to other sites in India and globally. • Engagement of students and physicians globally • Vibrant global online community and open-access learning platform, interfacing society with science as well as delivering improved care to more patients in real time.

  38. Weaknesses and Threats! • No takers in formal medical curriculum • Threat of usurping the formal medical curriculum • Patient privacy and confidentiality ethics optimization

  39. Summary paper

  40. Learning Points • EBME challenges: FBM, MBM, Traditional Curricula and limits of evidence • EBME Way forward: Patient centred, Community focused transformation

  41. Collaboration:rakesh7biswas@gmail.com

  42. Patient centred EBME: What it is not!

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