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Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships

Authors

  • Cristina Tomatis MD,

    1. General Physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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  • Claudia Taramona MD,

    1. General Physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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  • Emiliana Rizo-Patrón MD,

    1. General Physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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  • Fiorela Hernández MD,

    1. General Physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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  • Patricia Rodríguez MD,

    1. General Physician, Universidad Peruana Cayetano Heredia, Lima, Perú
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  • Alejandro Piscoya MD,

    1. Gastroenterologist, Hospital Nacional Cayetano Heredia, Lima, Perú
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  • Elsa Gonzales MD,

    1. Scientist
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  • Eduardo Gotuzzo MD,

    1. Director, Instituto de Medicina Tropical Alexander von Humboldt Universidad Peruana Cayetano Heredia, Lima, Perú
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  • Gustavo Heudebert MD,

    1. Associate Dean for Graduate Medical Education, Director of Internal Medicine Residency Program and Vice-Chair of Education and Faculty Development, University of Alabama at Birmingham and Professor of Medicine, Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Robert M. Centor MD,

    1. Associate Dean, University of Alabama at Birmingham – Huntsville Campus and Professor of Medicine, Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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  • Carlos A. Estrada MD MS

    Corresponding author
    1. Director, Veterans Affairs National Quality Scholars Program, Scientist, Deep South Center on Effectiveness, REAP Center for Surgical, Medical Acute Care Research & Transitions, Birmingham Veterans Affairs Medical Center and Professor of Medicine and Director, Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Dr Carlos A. Estrada, Birmingham Veterans Affairs Medical Center and the University of Alabama at Birmingham, 732 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3407, USA. E-mail: cestrada@uab.edu

Abstract

Rationale, aims and objectives  Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges.

Method  Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high).

Results  Totally 220 clinicians participated. For phase I (2005–2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008–2009), before the course, 8–72% graded their competence very low (score of 1–2). After the course, 67–92% of subjects graded their increase in knowledge very high (score of 4–5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed.

Conclusions  In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.

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