​Medical students who are trained in evidence-based healthcare (EBHC), are better equipped to provide quality care to patients.

“Evidence-based healthcare involves integrating clinical expertise acquired through clinical practice and experience with patient values and current best evidence within the broader healthcare context," explains Prof Taryn Young. She is the Head of the Centre for Evidence-based Healthcare at the University of Stellenbosch's Faculty of Medicine and Health Sciences.

She describes EBHC as “an approach that develops a health practitioner's ability to assess the quality of research evidence before applying it to day-to-day clinical problems". This competency is especially relevant given the resource constraints across the continent.

The best answers

Young, who holds a PhD on this subject, believes this approach adds “tremendous value" to the development of health professionals. She explains: “EBHC is about ensuring that whatever kind of treatment or care is offered, will be based on best research evidence. This is the case whether a choice has to be made about which medication to prescribe or whether decisions have to be taken about preventative strategies at a population level.

“This approach equips students with the relevant tools to be able to find the best answers. Essentially, EBHC involves assessing new research and then integrating it into practice.

“EBHC starts from a position where health practitioners acknowledge that they don't know everything. The fact that you graduate does not mean that you always know what best practice is, especially not at the rate that science is currently advancing."

Young has investigated how this approach to teaching and learning can best be integrated in undergraduate medical training in the Faculty, as well as elsewhere in Africa. Her research also focused on how the learning experience of undergraduate medical students can best be supported to enable them to follow an evidence-based approach when they start practicing.

“EBHC should therefore be at the core of the curriculum of all healthcare professionals to enhance students' knowledge, attitude and skills. It is beneficial to the entire healthcare team, allowing for a more holistic, effective approach to the delivery of healthcare."

This approach is especially useful given the need for healthcare professionals to keep abreast of new developments in order to offer care that works. They also need to be able to eliminate harmful or ineffective interventions.

Good versus bad science

“Health practitioners need to keep abreast of new scientific evidence and be able to sift through what is good science and what is not. Graduates must be able to track down relevant papers and engage with it critically. These are the kind of skills we want to cultivate in our graduates and healthcare practitioners," Young explains.

Her overview of systematic reviews assessing the effects of teaching EBHC indicated that clinically integrated strategies with assessment were more effective than single interventions or no interventions at all. “A combination of methods, including lectures, computer laboratory sessions, discussions in small groups, journal clubs, the use of real clinical issues, as well as portfolios and assignments, are more likely to improve knowledge, skills and attitudes."

She also conducted studies to determine the opportunities for, and barriers to, implementing this approach at the Faculty. This included a curriculum document review, interviews with academic convenors as well as a survey of recent graduates' perceptions and experiences.

Overcoming barriers

Some of the barriers to implementing EBHC learning at an undergraduate level include the clinical workload and competing priorities of students and lecturers. “The most common challenges by far for teaching EBHC are the perceived lack of space in the curriculum, misconceptions about EBHC, the resistance of staff, the lack of confidence of tutors, time constraints, as well as negative role‑modelling."

Her results indicate that EBHC can best be learnt when integrated in clinical practice. Young explains: “It helps to base teaching on real clinical decisions and actions and to focus on students' actual learning needs.

“EBHC should be part of the curriculum and there needs to be a clear scaffolding of learning. The foundation should be laid in the preclinical years and consolidated in the clinical years."

Young believes it is important for students to recognise the relevance of EBHC and link it with clinical realities. She explains: “We often tell students that they should be able to be good users of research. They should be able to look at research evidence, question it and use it. We want them to know what to do when they are faced with uncertainty when practicing medicine. The relevance of EBHC cuts across all disciplines, regardless of where you work."

According to Young the Faculty is in many ways at the forefront of implementing this approach at an undergraduate level. “Many institutions involved in medical training worldwide are grappling with ways to successfully implement this approach in their curricula. A lot of interest has been expressed in the work done at the Faculty in this regard, including from tertiary institutions in Namibia, Uganda, Ethiopia and Rwanda."

Young says implementing such a curriculum requires institutional support, a critical mass of the right teachers and role models in the clinical setting, and especially patience, persistence and pragmatism.

“Like their stethoscopes, EBHC should become a useful tool for students."

Caption: Prof Taryn Young.

Photo: Damien Schumann