Editor- the article "Evidence based medicine should be taught in medical schools" writes "most teaching of evidence based medicine for undergraduates takes a classroom based format"¹.

The lack of evidence-based medicine teaching and the dismissal of epidemiology as mere ‘biostatistics’ is appalling. The tendency for medical school nowadays is to push evidence-based medicine solely into pre-clinical teaching. In doing so, they risk students thinking of research as unimportant, and hence, the rote-learning of treatments as absolute doctrine. We must never forget that medicine is a constantly expanding science, and not an exact doctrine.

The incorporation of evidence-based medicine teaching in clinical years will not only allow students to become familiar with analysing relevant data, it will encourage consultants to keep up to date with research. Furthermore, astute evaluation of research allows greater patient rapport. The new Hippocratic Oath² states that ‘I will help patients find the information and support they want to make decisions on their care.’ Students can explain procedures and medications to patients so that they can make informed decisions, rather than taking advice based solely on trust³.

Specialties should consider welcoming undergraduate students into journal clubs for registrars and house surgeons. It will not only foster better communication within the ranks and a better understanding of research, but a real enthusiasm for the field. All medical students should be required to demonstrate competence in applying evidence-based medicine within the context of the socio-political environment and the national health care system, with its resource constraints⁴.

1. Wijesingh, M. Evidence based medicine should be taught in medical schools. StudentBMJ. 2005 Feb.
2. Longmore M, Wilkinson IB, Rajagopala S. Oxford Handbook of Clinical Medicine. 6th Ed. Oxford: Oxford University Press, 2004.
3. Ed. James DK, Mahomed K, Stone P, Van Wijngaarden W, Hill LM. Evidence-based Obstetrics: A Companion Volume to High Risk Pregnancy. 2nd Edition. Saunders. 2003.
4. University of Auckland: Medical and Health Sciences. Phase 2 (Year 5) Guidebook. 2005.

I agree with Manique Wijesinghe on his view that evidence based medicine should be taught in the medical schools.

Normally in undergraduate days research is not been given importance. But I feel a medical student should know basics of research like reviewing the literature or exposure to the articles of medical journals. Greatest advantage in evidence-based teaching is that it allows the medical students to think in line with research.

One of the ways of stimulating students towards the evidence-based learning is introduction of integrated method of teaching. Being an Anatomy teacher, I know how difficult for an undergraduate student to understand the Anatomy of an organ unless he realizes its clinical or surgical importance. In the conventional method of teaching there is not much scope for such correlation especially in preclinical subjects. But, in an integrated system of teaching where a student learns all the preclinical subjects together there is more scope for understanding things better.

Similarly, small group discussions among students can be encouraged by implementing the problem-based learning (PBL).

I conclude by saying that, Teaching evidence-based medicine is equally important in both pre clinical and clinical days of a medical student.

I cannot agree more with the article as well as the responses made. Let me share with you all my experience in Hong Kong.

I am the first batch of students under the "new curriculum" offered by the Chinese University of Hong Kong. We have been taught to use OVID or other medical related search engines starting from our first year of our study. We also learnt to critical appraise journals or studies in the second year. In the third and forth year, we have regular sessions helping us to ultilize the skills we learnt in earlier years in finding the best treatment or bet management plan for specific or controversial medical problems. We are also required to write up case reports regularly with suggestions in the plans of management with evidence to support our proposals.

All in all, medical school in Hong Kong are keeping up with the trend and had better equiped her students with the skills in facing the ever changing world in the field of medicine.

Editor,

While I agree that evidence based medicine is an essential part of medical training, I believe that the emphasis should more on the techniques on obtaining and assessing this knowledge, rather than blindly repeating what we are told by our lecturers. Selctive use of evidence can be used by tutors to prove a theory, or to substantiate a viewpoint as though no opposition to this stance exists. Common examples in teaching practice include the routine use of screening, where the evidence base is frequently used to outline the benefits, without also demonstrating the relative cost and downsides. Other examples could include selection of trial groups which are different to their target population, for example with anti-hypertensive medication. While this situation is better than repeating 'truths' for which there is no evidence, tutors need to be aware that there is usually evidence that goes against their viewpoint, and should encourage students to be aware of this.

Only by truly understanding the evidence and its limitations can we possibly hope to apply the principles to patient care.

This is in response to Manique Wijesinghe’s article entitled 'Evidence based medicine should be taught in medical schools'

There is a debate about what to teach to the undergraduate medical students? There are sayings like 'nothing could be taught; everything has to be learnt' and 'learning can happen without a teacher, but teaching can not happen without a learner' These sayings are with reference to student centered approaches like problem based learning (PBL). Today, in medical education, there are different types of teaching/learning methods; conventional method, problem based learning, evidence based learning, task based learning etc. A lot of innovations have been made but still, there is no single best method which is really promising. Each method has its own merits and demerits. Conventional method is accused of overloading information and providing passive learning environment, while the innovative methods are being accused of providing stress to the students and faculty and they are very costly in terms of resources. In an invited review, Laeora Berkson1says that the graduate of PBL Sc! hool is not better than the graduate of a conventional school. She further says that twenty five years of experiments with the educational process has not produced a distinctive, more competent physician.

It is agreed that evidence based teaching has to be popularized and it could be achieved through integrated approach. There are schools where horizontal2 and vertical integrations3 being tried. Some schools have a 'wedge approach' where, the amount of basic sciences taught decreases gradually from first year to the last year and the clinical subjects taught increase gradually from first year to the last year. A perfect integration of the subjects is near to impossible because it is very difficult to integrate all the subjects. Every subject has its own conventional way of teaching, which has been practiced since many years. All the teachers of conventional school are not ready to accept sudden changes in the curriculum.

The need of the time is to have a 'Hybrid curriculum' which doesn’t lose the values of the traditional discipline based curriculum; but at the same time keeps an open eye to invite and incorporate integrated problem based learning, evidence based learning, task based learning, self directed learning etc. The medical educators have to carefully plan and design such curricula and implement them in the universities.

1. Laeora Berkson. Problem-based learning: have the expectations been met? Acad Med. 1993 Oct;68(10 Suppl):S79-88. Review
2. Lowry S. Medical Education. Curriculum Design, British Medical Journal.1992; 305:1409-11.
3. Walton J.N. On training tomorrow’s doctors: the New Castle Curriculum revised and reconstructed. British Medical Journal.1977;1:1262-1265

I agree with this thinking because I think when we can produce research and articles accumulation from all sides of specific topic we can reach to main result easily.

It is very available method to reach main & correct results in one specific topic but I think if these results be with critical thinking about all articles it will be beter & students can sift all of them then apprasial their ideas about it, they can access to new result and more important research questions. we can use from all kindes of examples in more articles but we should only think about them and have jeneral view of them and at the end we can found one of them that is more suitable in EBM, even we can compare our ideas with correct and frequent results.

Tath`s correct EBM prevent us from confusing in understanding article but with more studies we can collect more experience from our topic and can diagnosie mistakes in ways that use each of this articles.