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