Medical Students Should Consider Evidence-Based Medicine

Sometimes it’s important to question time-tested physician practices.

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Practicing evidence-based medicine sometimes means bucking one’s medical school education.

Patients of all ages put a lot of faith in the medical community. When they're sick, they go to the doctor, and the doctor makes them feel better. However, patients frequently leave the doctor's office with little understanding of how or why their physician made a particular diagnosis.

Traditionally, doctors have made decisions regarding the best care for their patients based upon what their medical school and residency professors taught them. Often this has meant that the reasons for treating a patient a certain way were based upon information that had been passed down through several generations. But modern medicine has evolved—which is where something called evidence-based medicine comes in.

Today's top physicians and surgeons are empowered with real data, not dogma, and are practicing evidence-based medicine. This requires a collaborative effort between scientific researchers, physicians, and patients, so that the diagnosis and treatment provided at the clinical level lead to better patient outcomes. This group effort creates a solid foundation that is based upon physicians' observation of both patients and scientific data and offers a reasonable, more definite outlook on how the patient will respond.

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What exactly is evidence-based medicine? Evidence-based medicine (EBM) uses real data to help determine the best mode of treatment for patients. It often requires young physicians to question treatments that they have been taught and to think outside the box. It also integrates expertise at the clinical research level, using physician knowledge and recorded patient outcomes to help make treatment decisions.

Most instances involving evidence-based medicine will, in fact, be wrapped around known patient-based experiences and results. But evidence-based medicine can also be focused on basic anatomic or biomechanical studies, which compare one patient to another in order to determine the effects of restoring normal body function.

For example, say you are treating a complex knee injury. Historically, your patient would be put in a cast and eventually would have recurrent knee instability. However, a physician who practices evidence-based medicine would apply anatomically-based techniques to reconstruct the torn ligaments, which studies have shown deliver better outcomes for patients.

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How does evidence-based medicine affect students? EBM has been incorporated into the medical school experience at several institutions, including the Medical School at University of Minnesota—Twin Cities and Dartmouth Medical School.

For example, at Dartmouth's medical school and at Dartmouth-Hitchcock Medical Center have infused EBM into teaching at a variety of levels. In addition to a biostatistic and epidemiology course taught in the second year of medical school, Dartmouth maintains a resource website, which students and residents use frequently.

EBM has also permeated the curriculum at many levels. As more and more faculty have become comfortable with the concepts that underlay EBM, the conversational domain of EBM has informed lectures, as well as bedside teaching. Learners at Dartmouth are constantly pushed to use evidence to back up their clinical decisionmaking.

Here's how to get started: Evidence-based medicine can be performed in a university setting; in a private practice associated with a residency program, research institute, or foundation; or it can even be practiced in a solo-based practitioner model. The only requirement is that one who wants to practice EBM obtain Institutional Review Board (IRB) approval for any studies based on patients, due to laws stipulating that all patients must consent to participation in any study prior to completing any questionnaires that document outcomes scores.

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The most effective EBM studies are prospective, double-blinded—when neither the researcher nor the patient is aware of which treatment the patient is receiving—and compare one form of treatment to another. In these circumstances, whether the study is comparing one drug to another for a specific condition, or comparing a surgical approach to a nonsurgical approach, it can often definitively answer the best means to treat a patient with a specific condition or illness.

There are endless opportunities for prospective physicians to choose the course of medicine in which they will practice. While every physician enters the world of medicine with a specific specialty in mind, it cannot be debated that the evidence-based medicine approach is gaining momentum. There are even specific medical facilities and institutes throughout the world that specifically teach and guide their students and fellows based on this method.

Evidence-based medicine is becoming a specialty in its own right, and it's an area that medical students should pay close attention to when determining their path.

Robert LaPrade, M.D., Ph.D., is a complex orthopedic knee surgeon at The Steadman Clinic in Vail, Colo., and director of biomechanics research for the Steadman Philippon Research Institute. Consistently selected as one of the "best doctors in America" by his peers, he is an expert in treating difficult and compound knee injuries such as posterolateral knee injuries, PCL tears, revision ACL reconstructions, and MCL injuries. He is also an adjunct professor of orthopedic surgery at the University of Minnesota—Twin cities Medical School.