How to make EBM easy to swallow: BMJ PICO

8 02 2009

Guest author: Shamsha Damani (@shamsha)

As a medical librarian, I try to instill the importance of Evidence Based Medicine (EBM) to all my users. They agree that EBM is important, and yet, still resort to shortcuts (like using Google, asking colleagues, etc). And you know what, I don’t blame them. Given the amount of medical literature published today, it is very difficult to keep up with it all. There are some very bad and poorly designed studies published, which makes it difficult to identify good ones. And once you’ve identified a good article to read, evaluating and critiquing it is another daunting task. I keep wondering if this has to be so difficult. Shouldn’t there be stricter standards for publications? Shouldn’t publishers care about the quality of research that is associated with their name? I know that some journals like ACP Journal Club critique articles but they don’t cover nearly enough topics.

As I pondered these thoughts, something very interesting happened that gives me hope. BMJ recently announced that they will be publishing two summaries for each research article published. One is called BMJ PICO, is prepared by the authors, and breaks down the article into the different EBM elements. The other is called Short Cuts, which is written by BMJ itself. This is where I hope BMJ will shine, provide an unbiased view of the article, and set itself apart from other journals by doing some extra work. Imagine reading a brief synopsis of a research article, not written by the author, which will tell you whether the study was any good and if the results were valid. What a time saver! I hope that BMJ continues this practice and that other journals follow suit. Right now BMJ is still testing the waters and trying to figure out which format would be most appealing to readers. Personally I think it would have been better to have the BMJ reviewers write the PICO format, and do a bit more thorough critiquing. The reviewers already critique the article before it gets accepted; it only makes sense that the results of such a thorough critique be published as well. An unbiased view would make it easier for readers to trust (or not!) the results and proceed accordingly.

I still believe that EBM skills are very important and should be learned.
However, busy health care providers will find value in such pre-packaged articles and will use the evidence more if it has been critiqued already. And isn’t that the point of EBM: to make more use of the evidence?

Shamsha Damani, Clinical Librarian

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8 responses

8 02 2009

Great guest post.

Critical appraisal just takes too long for clinical practice. It will be interesting to see how these summaries appeal to clinicians – research seems to show that they love Cochrane, DARE, etc, precisely because of the POEM quality of the material. How many clinicians have to work from the abstracts of reviews and other research articles because of lack of time at the coalface?

The more accurate summaries available, the better for the clinicians …

8 02 2009
Ulrich Schrader

I think we still focus to much on the process of EBM. In clinical practice the focus is on the product of EBM. Simplified for a clinician there are basically two questions:

1. What is the best treatment (diagnosis) for … ?
2. Are there new EBM results I have to consider for my practice?

These questions should be answered quickly and in a non-ambiguous way. Critical appraisal especially of ambiguous results costs time. Going through several databases or journals is time consuming and costly.

Probably easy to swallow would be an open-access, comprehensive, concisely written, prioritized, and well indexed (quick to search) source with links to more detailed sources for further readings.

9 02 2009
Shamsha Damani

Thanks for the positive comments. I think that some publishers are getting the message and are trying to change in creative ways to set themselves apart from the plethora of other medical journals out there.

As far as an open access, concisely written, and well indexed database goes, well, that would be a librarian’s dream come true!

22 02 2009
Medicine 2.0 Blog Carnival Edition #37 | Health Blogs Observatory

[...] Clinical Librarian Shamsha Damani @shamsha has notified us about the new initiative from the BMJ Publishing Group which should make Evidence Based Medicine easy to swallow. [...]

28 02 2009

Making EBM resources understandable and of “daily-usefulness” is (IMHO) a difficult concept to teach and to get medical students to investigate. And students will always follow the lead of their advisors and clinical instructors in terms of what to value as the “most credible” sources.

Many of the clinicians I work with began practicing medicine and treating patients long before the internet made educational or training materials readily available digitally. Their knowledge base is in their heads… and not necessarily online. One cannot argue with that because their lifelong experience is what allows them to be excellent clinical (reality-based) instructors. Their educational decisions is what allow students to pass their examinations with excellent results! The outcome is time-tested, and positive.

My goal (as a librarian and instructor) is to convince, persuade, demonstrate to the medical students the usefulness of our diverse subscription resources… and to please stop using Wikipedia and Google Scholar. (!)

As they move through their four years of medical education and gain accumulated clinical experience, the students’ information requirements also change.

TRIP (Turning Research Into Practice), Essential Evidence, ACP Journal Club reviews are all good for examining individual, experienced clinicians’ thinking about “what argues for/what argues against” a particular treatment or therapy. Medical librarians can be essential motivators (even “salesmen”) and demonstrators in getting students to explore other resources which may prove to be highly useful to their long-range learning issues.

6 03 2009
Health Highlights - March 6th, 2009 | Highlight HEALTH

[...] How to make EBM easy to swallow: BMJ PICO | Laikas MedLibLog [...]

9 11 2009
Ask A Doctor

Its true that many medical students as well as graduates are using internet as their main source for medical information. We all know that this can be very dangerous.

8 08 2010
Collaborating and Delivering Literature Search Results to Clinical Teams Using Web 2.0 Tools « Laika's MedLibLog

[...] The paper of Shamsha Damani and Stephanie Fulton published in the latest Medical Reference Services Quarterly [1] falls in the latter category. Perhaps the name Shamsha Damania rings a bell: she is a prominent twitterer and has written quest posts at this blog on several occasions (here, here, here and here) [...]

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