A real-world approach to Evidence-Based Medicine in general practice: a competency framework derived from a systematic review and Delphi process

Abstract

BackgroundEvidence-Based Medicine (EBM) skills have been included in general practice curricula and competency frameworks. However, GPs experience numerous barriers to developing and maintaining EBM skills, and some GPs feel the EBM movement misunderstands, and threatens their traditional role. We therefore need a new approach that acknowledges the constraints encountered in real-world general practice. The aim of this study was to synthesise from empirical research a real-world EBM competency framework for general practice, which could be applied in training, in the individual pursuit of continuing professional development, and in routine care. We sought to integrate evidence from the literature with evidence derived from the opinions of experts in the fields of general practice and EBM.MethodsWe synthesised two sets of themes describing the meaning of EBM in general practice. One set of themes was derived from a mixed-methods systematic review of the literature; the other set was derived from the further development of those themes using a Delphi process among a panel of EBM and general practice experts. From these two sets of themes we constructed a real-world EBM competency framework for general practice.ResultsA simple competency framework was constructed, that acknowledges the constraints of real-world general practice: (1) mindfulness - in one’s approach towards EBM itself, and to the influences on decision-making; (2) pragmatism – in one’s approach to finding and evaluating evidence; and (3) knowledge of the patient – as the most useful resource in effective communication of evidence. We present a clinical scenario to illustrate how a GP might demonstrate these competencies in their routine daily work.ConclusionWe have proposed a real-world EBM competency framework for general practice, derived from empirical research, which acknowledges the constraints encountered in modern general practice. Further validation of these competencies is required, both as an educational resource and as a strategy for actual practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0916-1) contains supplementary material, which is available to authorized users.

Evidence-based practice education for healthcare professions: an expert view

“…Further emphasis on communication skills was also noted as being key to enhancing EBP competency, particularly in relation to realising shared decision-making between patients and healthcare practitioners in making evidence-based decisions. A systematic review by Galbraith et al ,12 which examined a ‘real-world’ approach to evidence-based medicine in general practice, corroborates this recommendation by calling for further attention to be given to communication skills of healthcare practitioners within the context of being an evidence-based practitioner. This resonates with recommendations by Gorgon et al 13 for the need to expose students to the intricacies of ‘real world’ contexts in which EBP is applied.…”

Інформаційне Забезпечення Доказового Ведення Пацієнтів З Ураженнями Кістково-М’язової Системи В Первинній Ланці Охорони Здоров’я

“…Information support implies primarily gathering and processing of information necessary for the executive decision making; it is a «systemic element of global health care policy» [1] and its modern paradigm − evidence-based medicine (EBM) [4][5][6]. A number of international declarations, starting with the Ottawa Charter for Health Promotion (1986) recognize expert analysis of information as the basis for a scientific support of reforms, and note both the importance of improved information support of PHC and the vulnerability of this link's implementing EBM [1,[7][8].…”

Applying evidence-based medicine in general practice: a video-stimulated interview study on workplace-based observation

“…General practice (GP) specialty training focuses on the first three steps: asking the right questions, searching for evidence and appraising that evidence [4][5][6]. However, to provide best care for individual patients, EBM training should also focus on EBM behaviour: learning to judiciously weigh the best available evidence in combination with the patient's preferences, and one's own clinical expertise, leading to an individual decision that is well-grounded [3,4,[7][8][9][10]. Currently, the best way to learn EBM behaviour in the workplace is unknown.…”