Pharmacy educators: Can an evidence-based approach make your instruction better tomorrow than today?

American Journal of Pharmaceutical Education, Spring 2002 by Beck, Diane E

Council of Faculties Chairman's Section

"Though it is not my opinion. I think there is no sense in forming an opinion when there is no evidence to form it on. If you build a person without any bones in him he may look fair enough to the eye, but he will be limber and cannot stand up; and I consider that evidence is the bones of an opinion. "

Mark Twain's - Personal Recollections of Joan of Arcs

INTRODUCTION

In the last 10 years learning strategies such as active learning, studentcentered learning, problem-based learning, performance-based assessment, and outcomes-based assessment have transformed our Doctor of Pharmacy programs. Based on what you know about these programs today, do they have the "bones" to stand up and maintain their existence or will they just be another passing educational fad?

In order to become better tomorrow than we are today in pharmacy education we need to assess whether our current teaching approaches really have the "bones" needed to prepare pharmacy graduates for practice today and in the future. I propose that pharmacy faculty members can accomplish this by approaching their teaching and curricular decisions much like they do research in their laboratories or clinical research centers. Specifically, they need to apply a methodical thinking process that includes consideration of the "best evidence" available when making teaching and curricular decisions.

As a Council of Faculties, how can we enable ourselves and future colleagues to make such a thinking process a routine part of our responsibility as a faculty member? Although the Task Force on Best Evidence Pharmacy Education will be addressing this issue this year, I believe the Task Force and other members of the Council of Faculties would benefit from some background information about this "evidence-based movement" in our society and questions and issues that I believe we need to address as a Council of Faculties in order to proactively ensure our curricula have "bones." Therefore, the following section provides this information for the purpose of stimulating thought and dialogue among both the Task Force and other Council of Faculties members.

BACKGROUND

Evidence-based approaches to decision-making are not new; in fact, evidence-based medicine is thought to have evolved during the mid19th century or earlier in Paris(l). However, it did not get much attention until Professor David Sackett applied the concept in teaching Canadian medical students about how to solve clinical problems in the 1980s(2). Sackett has defined evidence-based medicine as "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." This practice involves "integrating individual experience with the best available external clinical evidence from systematic research"(1). Meta-analyses of literature and other data analysis strategies serve as the external evidence.

For those who are not familiar with Sackett's work, he has emphasized that the best available external clinical evidence involves research findings from both the basic sciences and patient centered clinical research. He emphasizes that good physicians use both clinical expertise and the best available external evidence. Sackett also emphasizes that evidence-based medicine is not impossible to practice, not "cook-book" medicine, and not restricted to randomized trials and meta-analyses.

Sackett's accomplishments prompted educators in Europe to assert that educators needed to become more "evidence-based"2(3). This work also caught the attention of medical educators in Europe. However, to emphasize that these decisions realistically involve both rigorous research data and expertise/experience in teaching, the medical educators coined the term "Best Evidence Medical Education" or BEME. BEME is defined as "the implementation, by teachers in their practice, or methods and approaches to education based on the best evidence available"(4,5). Following several conferences in 1999, individuals from Europe, North America, the Middle East, and Australia have joined together and established the BEME Collaboration Group.3 The mission of this organization is to promote BEME by disseminating information, establishing resources and the methodology for producing systematic reviews of education issues, and creating a culture among all levels of medical educators that BEME involves a thinking process that is an intrinsic component of good teaching practice.3 Early discussions by this group have indicated interest in broadening their discussions to other healthcare professions(4). Should pharmacy educators seek involvement with this Group?

Some readers may be rightfully doubting at this point and questioning whether this concept in medicine has applicability to pharmacy education. You may be even reflecting that education is "not really science" and therefore, "evidence-based" thinking has questionable relevance in pharmacy education. I beg your patience and encourage you to read further so that we as a Council of Faculties can assess whether an evidence-based approach to pharmacy education can help us ensure it has the "bones" necessary for the test of time.