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Evidence-Based Medicine in the Education of Psychiatrists

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Abstract

Objective

Evidence-based medicine has an important place in the teaching and practice of psychiatry. Attempts to teach evidence-based medicine skills can be weakened by conceptual confusions feeding a false polarization between traditional clinical skills and evidence-based medicine.

Methods

The author develops a broader conception of clinical expertise consisting of three tasks, clarifies the role of evidence-based medicine and explores the implications for teaching and practice.

Results

Evidence-based medicine is an essential tool that enables clinicians to assess causal explanations in etiology, risk, or prognosis or to compare treatments.

Conclusion

An explicit and inclusive conceptualization of clinical skills can provide a framework to implement and assess curricular efforts to teach evidence-based medicine.

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References

  1. Feinstein AR: Clinical Judgment. Williams & Wilkins, 1967

  2. Evidence-Based Medicine Working Group: Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992; 268: 2420–2425

    Article  Google Scholar 

  3. Goldner EM, Bilsker D: Evidence-based psychiatry. Can J Psychiatry 1995; 40: 97–101

    CAS  PubMed  Google Scholar 

  4. Yager J, Greden J, Abrams M, et al: The institute of medicine’s report on research training in psychiatry residency: strategies for reform-background, results, and follow up. Acad Psychiatry 2004; 28: 267–274

    Article  PubMed  Google Scholar 

  5. Roberts LW, Coverdale JH, Louie AK: Evidence, methods, and psychiatric education. Acad Psychiatry 2003; 27: 227–228

    Article  PubMed  Google Scholar 

  6. Fenton W, James R, Insel T: Psychiatry residency training, the physician-scientist, and the future of psychiatry. Acad Psychiatry 2004; 28: 263–266

    Article  PubMed  Google Scholar 

  7. Straus SE, McAlister FA: Evidence-based medicine: a commentary on common criticisms. CMAJ 2000; 163: 837–841

    CAS  PubMed Central  PubMed  Google Scholar 

  8. Levine R, Fink M: The case against evidence-based principles in psychiatry. Med Hypotheses 2006; 67: 401–410

    Article  PubMed  Google Scholar 

  9. Salzman C: The limited role of expert guidelines in teaching psychopharmacology. Acad Psychiatry 2005; 29: 176–179

    Article  PubMed  Google Scholar 

  10. Gray GE: Concise Guide to Evidence-Based Psychiatry. Arlington, Va, American Psychiatric Publishing, 2004

    Google Scholar 

  11. Richardson WS: Teaching evidence-based practice on foot. ACP J Club 2005; 143: A10–12

    PubMed  Google Scholar 

  12. March JS, Chrisman A, Breland-Noble A, et al: Using and teaching evidence-based medicine: The Duke University child and adolescent psychiatry model. Child Adolesc Psychiatr Clin N Am 2005; 14: 273–296, viii-ix

    Article  PubMed  Google Scholar 

  13. Osser DN, Patterson RD, Levitt JJ: Guidelines, algorithms, and evidence-based psychopharmacology training for psychiatric residents. Acad Psychiatry 2005; 29: 180–186

    Article  PubMed  Google Scholar 

  14. Geddes JR: Evidence-Based Mental Health. London, BMJ, 1998

    Google Scholar 

  15. Srihari V, Martin A: Gained in translation: evidence-based medicine meets pediatric psychopharmacology. Child Adolesc Psychiatr Clin N Am 2006; 15: 263–287

    Article  PubMed  Google Scholar 

  16. Srihari VH: Pulmonary embolism in a patient taking clozapine. BMJ 2008; 336: 1499–1501

    Article  PubMed  Google Scholar 

  17. Bilsker D, Goldner EM: Teaching evidence-based practice in mental health. Evid Based Ment Health 1999; 2: 68–69

    Article  Google Scholar 

  18. Sackett DL: Evidence-Based Medicine: How to Practice and Teach EBM. Edinburgh; New York, Churchill Livingstone, 2000

    Google Scholar 

  19. Greenhalgh T: Papers that summarise other papers (systematic reviews and meta-analyses). BMJ 1997; 315: 672–675

    Article  CAS  PubMed  Google Scholar 

  20. Green ML: Evidence-based medicine training in graduate medical education: past, present and future. J Eval Clin Pract 2000; 6: 121–138

    Article  CAS  PubMed  Google Scholar 

  21. Eraut M: Expert and expertise: meanings and perspectives. Learning Health Soc Care 2005; 4: 173–179

    Article  Google Scholar 

  22. Hakkarainen K, Palonen P, Paavola S, et al: Communities of Networked Expertise: Professional and Educational Perspectives. Amsterdam, Elsevier, 2004

    Google Scholar 

  23. Fish FJ, Hamilton M: Fish’s Clinical Psychopathology: Signs and Symptoms in Psychiatry. Bristol, Wright, 1985

    Google Scholar 

  24. Sims A: Symptoms in the Mind: An Introduction to Descriptive Psychopathology. Edinburgh; London, Saunders, 2003

    Google Scholar 

  25. Havens LL: Approaches to the Mind: Movement of the Psychiatric Schools from Sects Toward Science. Boston, Little, Brown, 1973

    Google Scholar 

  26. McHugh PR, Slavney PR: The Perspectives of Psychiatry. Baltimore, Johns Hopkins University Press, 1998

    Google Scholar 

  27. Ghaemi N: The Concepts of Psychiatry: A Pluralistic Approach to the Mind and Mental Illness. Baltimore, Johns Hopkins University Press, 2003, pp 299–308

    Google Scholar 

  28. Jaspers K: General Psychopathology. Manchester, England; Chicago, University of Chicago Press, 1963

    Google Scholar 

  29. Evidence-Based Medicine Working Group, American Medical Association, Guyatt G, Rennie D: Users’ Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice. Chicago, American Medical Association Press, 2002

    Google Scholar 

  30. Addington J: Cannabis use increases the risk of young people developing psychotic symptoms, particularly if already predisposed. Evid Based Ment Health 2005; 8: 87

    Article  PubMed  Google Scholar 

  31. Geddes J: Asking structured and focused clinical questions: essential first step of evidence-based practice. Evid Based Ment Health 1999; 2: 35–36

    Article  Google Scholar 

  32. Hatcher S, Oakley-Browne M: Evidence-Based Mental Health Care. Edinburgh; New York, Elsevier Churchill Livingstone, 2005

    Google Scholar 

  33. Steiner JF: Talking about treatment: the language of populations and the language of individuals. Ann Intern Med 1999; 130: 618–622

    Article  CAS  PubMed  Google Scholar 

  34. Greenhalgh T: Narrative-based medicine: narrative-based medicine in an evidence-based world. BMJ 1999; 318: 323–325

    Article  CAS  PubMed  Google Scholar 

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Authors

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Correspondence to Vinod Srihari M.D..

Additional information

I am grateful for comments from Andres Martin, Schuyler Henderson, and Stuart Carney. I am also thankful to Dan Bilsker who provided the template for Figure 1.

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Srihari, V. Evidence-Based Medicine in the Education of Psychiatrists. Acad Psychiatry 32, 463–469 (2008). https://doi.org/10.1176/appi.ap.32.6.463

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  • DOI: https://doi.org/10.1176/appi.ap.32.6.463

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