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R ic a r d o S h o W K o m a t s uEvidence based m edicine is the conscientious, explicit, and
judicious use of current evidence in m aking decisions about
the care of individual patients!
T h e 2 n d . U .K . W o rk s h o p o n E v id e n c e B a s e d H e a lth C a re , L o n d o n , 1 1 th -1 6 th F e b ru a ry 1 9 9 6 , w ith D r. T ris h a G re e n h a lg h (U C L M S ) a s c o -o rd in a to r, a n d P ro f. D a v id S a c k e tt (O x fo rd ), a s o rie n ta to r, c o n s titu te d a n im p o rta n t m e e tin g to d is s e m in a te E B H C in U K a n d E u ro p e . "E v id e n c e B a s e d M e d ic in e is th e c o n s c ie n tio u s , e x p lic it, a n d ju d ic io u s u s e o f c u rre n t b e s t e v id e n c e in m a k in g d e c is io n s a b o u t th e c a re o f in d iv id u a ls p a tie n ts " (S a c k e tt, 1 9 9 6 ). T h e m e th o d o lo g y u tiliz e d w a s P ro b le m -B a s e d L e a rn in g (P B L ), w ith s m a ll g ro u p s s e s s io n s w ith tu to r a n d c o -tu to r a s fa c ilita to rs o f th e d is c u s s io n p ro c e s s . T h e p a rtic ip a n ts h a v e b e e n d e m o n s tra te d th a t it's p o s s ib le to te a c h E B H C u s in g d iffe re n t s tra te g ie s , a p p ro a c h e s a n d re s o u rc e s . T h is W o rk s h o p w a s a n e x c e lle n t o p p o rtu n ity n o t o n ly to s h a re a n d re c e iv e in fo rm a tio n s a b o u t C lin ic a l E p id e m io lo g y , B io s ta tis tic s a n d E B H C , b u t a ls o to p a rtic ip a te in a "le a rn in g to le a rn " a c tiv e p ro c e s s to u n d e rs ta n d h o w to te a c h a n d le a rn E B H C .
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h e "2 n d U n ited K in g d o m W o rk sh o p o n E v id en ce B ased H ealth " C are w as h eld at W h ittin g to n H o sp ital, L o n d o n , ad d ressin g th e th em e "E .B .M . - E v id en ce-B ased M ed icin e," u sin g th e m eth o d o lo g ical ap p ro ach o f P ro b lem -B ased L earn in g (P .B .L .),i.e.,
b ased o n an activ e p ro cess o f teach in g an d learn in g in sm all g ro u p s (o n av erag e eig h t stu d en ts)rely in g o n facilitato rs (a tu to r an d co -tu to r).T h e activ ities w ere d ev elo p ed u n d er th e au sp ices o f th e D ep artm en t o f P rim ary A tten tio n , U C L M S U n iv ersity -C o lleg e L o n d o n M ed ical S ch o o l, h ead ed b y P ro fesso r A n d y H ain es. D r. T rish a G reen h alg h co o rd in ated th e activ ities, w h ich w ere u n d er g en eral d irectio n o f P ro fesso r
A d d r e s s f o r c o r r e s p o n d e n c e :
R ic a r d o S h o it i K o m a t s u
M e d ic in e C o lle g e o f M a r f lia
A v . B r ig . L u is A n t o n io , 3 8 8 -c j. 3 5 -B e la V is t a S a o P a u lo / S P - B r a s il- C E P 0 1 3 1 8 - 0 0 0
D av id S ack ett, fro m th e E .B .M . W o rk in g G ro u p , O x fo rd U n iv ersity .
B esid es th e p len ary sessio n s (tw o w ith P ro fesso r S ack ett "O n th e N ecessity o f E v id en ce-B ased M ed icin e" an d "F o cu sin g o n C lin ical Q u estio n s") w e p articip ated in . m eetin g s w ith lib rarian s to estab lish research strateg ies fo r M ed lin e, d em o n stratio n s o f d atab ases, (N .H .S . an d C o ch ran e C en ter), an d in activ ities o f th e g ro u p
Public
Health
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as p art o f th e P ro ject U .N .I.-M arflia (K ello g g F o u n d atio n ), tu to red b y D r. K en n ed y C ru ik sh an k , S en io r L ectu rer in C lin ical E p id em io lo g y at M an ch ester U n i v ersi ty , an d D r. M ary W alk er, co -tu to r, R esearch A d m in istrato r, C o -D irecto r o f th e B ritish R eg io n al H ealt S tu d y ; b o th w ith lo n g ex p erien ce in th e sm all g ro u p d y n am ics.T h e g ro u p w as h etero g en eo u s, critical (I b eliev e th ere w as a b ias in th e selectio n o f can d id ates fo r th e W o rk sh o p ), an d rich in ex p erien ces o f teach in g , research , an d assistan ce. T h e g ro u p w as fo rm ed b y P ro f. D .G . C ram p , clin ical p ath o lo g ist, o f H ealth M an ag em en t, H ealth M an ag em en t G ro u p , C ity U n iv ersity , L o n d o n ; D r. V alerie
1191
F is c h e r, h e a d o f th e G ra d u a te S tu d ie s o n N u rs in g , H e rtfo rd s h ire U n iv e rs ity ; D r. J e n n ife r W o rro l, rh e u m a to lo g is t a t W h ittin g to n H o s p ita l; D r. R u m o n a D ic k s o n , re s e a rc h e r a t N .H .S . C e n tre fo r R e v ie w s a n d D is s e m in a tio n , Y o rk U n iv e rs ity ; D r. J o h n R o b s o n , a s s o c ia te p ro fe s s o r in E p id e m io lo g y a t A u c k la n d U n iv e rs ity (N e w Z e a la n d ); D r. M a ry P ie rc e , s e n io r le c tu re r in P u b lic H e a lth a n d P rim a ry A tte n tio n , H u ll U n iv e rs ity ; a n d D r. M e ry l D e a n e , le c tu re r/c o n s u lta n t in P u b lic H e a lth a n d P rim a ry A tte n tio n , C h e ls e a & W e s tm in s te r H o s p ita l, L o n d o n . F o llo w in g th e firs t " ic e b re a k e r" s e s s io n s , w e fo rm e d a re a l te a m , c o n c e n tra tin g o n : " s e e o n e ," " d o o n e " a n d " te a c h o n e ," a n d in " tim e in " a n d " tim e o u t."
It w a s a ric h e x p e rie n c e to s h a re a n d re c e i v e in fo rm a tio n n o t o n ly o n E v id e n c e B a s e d M e d ic in e , b u t a ls o o n h o w to te a c h , u s in g th e P B L m e th o d o lo g y . It b e c a m e e v id e n t th a t th e re a re d iffe re n t p re s e n ta tio n s , fo rm a ts , c o m p o s itio n s , s tra te g ie s a n d p o s s ib ilitie s u s e d in p ro b le m -b a s e d le a rn in g fo r th e tra n s m is s io n o f in fo rm a tio n . T h e s e m a k e th e e x is te n c e o f a c tiv e s tu d e n ts a n d p a rtic ip a n ts n e c e s s a ry fo r e x c h a n g in g in fo rm a tio n , s o th a t. tu to rs a n d s tu d e n ts h a v e th e 0 p p 0 l1 u n ity to a d d to e x is tin g in fo rm a tio n . It b e c a m e c le a r th a t th e a p p ro a c h fo r te a c h in g E v id e n c e B a s e d M e d ic in e in g ra d u a te c o u rs e s m u s t b e a s s o c ia te d w ith P B L m e th o d o lo g y , w h ic h is c u rre n tly b e in g d e v e lo p e d b y u s in a p ro g ra m fo r tu to r e d u c a tio n , a d v is e d b y p ro fe s s o rs fro m M a c M a s te r U n iv e rs ity . W e in te n d to o ffe r a n In te ra c tiv e U n it fo r E v id e n c e B a s e d H e a lth C a re , in P B L , a s a n e le c tiv e c o u rs e fo r fo u rth -y e a r m e d ic a l
s tu d e n ts , b y th e e n d o f th is y e a r. T h is p ro p o s a l w a s p re s e n te d , a n a ly z e d w ith g re a t re c e p ti v e n e s s , a n d a p p ro v e d b y th e g ro u p a t th is W o rk s h o p .
T h e M a rflia M e d ic a l F a c u lty , s tim u la te d b y th e in s titu tio n a liz a tio n o f U N I-M a rilia P ro je c t (" A N e w In itia tiv e fo r In te g ra tio n " o f a c a d e m y -h e a lth s e rv ic e -c o m m u n ity ), h a s b e e n e n g a g e d in th e S P IC E m o d e l fo r a p ro p o s a l o f a la rg e -s c a le c u rric u la r re v is io n : e d u c a tio n c e n te re d o n th e S tu d e n t, b a s e d o n P ro b le m s , In te g ra te d , o rie n ta te d to th e C o m m u n ity , a n d w ith E le c tiv e c o n te n t. P ro fe s s o r S a c k e tt b e l ie v e s th a t th i s e s s e n ti aI
m o v e m e n t to w a rd s th e ra tio n a liz a tio n o f m e d ic a l p ra c tic e , c o n c e iv e d a t M c M a s te r U n iv e rs ity , C a n a d a , w ill s p re a d ra p id ly th ro u g h o u t th e e n tire U n ite d K in g d o m b y th e e n d o f th is c e n tu ry , a n d w ill c o n s titu te a n im p o rta n t in flu e n c e fo r th e e n tire E u ro p e a n C o m m u n ity .
T o s p e a rh e a d th is m o v e m e n t in B ra z il, w e a re c o u n tin g o n th e C e n te r fo r R e s e a rc h a n d T ra in in g in C lin ic a l E p id e m io lo g y , E s c o la P a u lis ta d e M e d ic in a , S a o P a u lo F e d e ra l U n iv e rs ity , th e C lin ic a l E p id e m io lo g y U n its o f U F R J , a n d in th e n e a r fu tu re , o n th e p a s rtic ip a tio n o f C e a ra F e d e ra l U n iv e rs ity , M a rllia M e d ic a l F a c u lty , a n d th e S ta te U n iv e rs ity o f L o n d rin a .
A s s o o n a s p o s s ib le , w e h o p e to d e v e lo p in ic ia tiv e s s im ila r to th o s e o f th e U n ite d K in g d o m h e re , s in c e E v id e n c e B a s e d M e d ic in e is a c o n c re te s te p fo r th e d e fin ite in c o rp o ra tio n o f c lin ic a l e p id e m io lo g y k n o w le d g e , a s w e ll a s fo r th e c ritic a l e v a lu a tio n o f m e d ic a l lite ra tu re in o u r d a ily p ra c tic e .
L
REFERENCES
I. S a c k e tt D L , e t a l. E v id e n c e b a s e d m e d ic in e : w h a t it is a n d w h a t it is n 't. B M J 1 9 9 6 ;3 1 2 :7 1 -2 .
K O M A T S U , R .S . - E v id e n c e b a s e d m e d ic in e is th e c o n s c ie n tio u s , e x p lic it, a n d
ju d ic io u s u s e o f c u r r e n t e v id e n c e in m a k in g d e c is io n s a b o u t th e c a r e o f in d iv id u a l p a tie n l~
