I think it is posible because there are more perspetives to study

Sir, in dentistry there is a concept of comprehensive care. I am involved with interns in comprehensive training at this stage, It involves diagnosis and treatment of a patient for complete oral health care for all his problems. It involves multi speciality care of the patient under one clinician as in general practice setting with a help of specialist wherever needed. I usually encourage the students to plan and execute treatment based on literature search supporting his treatment plan/ choice of treatment and techniques which they can discuss during the final presentation of case after treatment.

Physicians have been reluctant/resistant? to accept evidence-based practice.  New physicians, i.e. medical students, should be exposed, trained, and encouraged to use, promote and contribute to evidence-based treatment, including  conducting and/or participating in the research that results in treatments/therapies/preventions that are effective.

Physicians and other medical providers can then use evidence-base practice, i.e that which is based on research.

I agree with previous colleages. Note that evidence based medicine may be a solid base for clínical practice, however this approach does not has answers for all the patients and doctors needs.

Thank you , yes, but does ANY treatment approach? 

Evidence-based is, theoretically, neutral.  And it can be used selectively for patient cases.  I do not understand how it can not be used for practice if it it indeed can be tailored to patients and doctors.  It is based on evidence.

The main sources of evidence-based medicine are RCT and meta-analysis. These items report data about effectiveness of treatments (or diagnostic tests, etc.) as proportion of responders, or average of clinical improvements versus control groups. These data have a great value in general terms but their meaning for the individual patient is less clear. In most cases we can not preview if our individual patient will be a responder or a non responder to an 'effective' treatment, and we can not preview if his/her response will be upper or under the average. Moreover, in daily clinical practice we don't need to discount the placebo effect of a treatment, instead of this we must to use and promote this effect.

In a few words, in my opinion the strategy is to choose the best treatment (or diagnostic, etc.) option according the evidence, and considering the patient preferences and individual determinants, and then (always) assessing the particular effectiveness of the intervention in this patient.

Have a nice weekend,

There are different types of evidence that can be relevant depending on the context and scope of this question. There is a growing evidence-base in regards to the education process itself. For instance, what do we know about differences between novices and experts, what are the differences between deductive and inductive learning processes, how can we create efficiencies and optimize pathways for different types of learning (eg. differences between declarative knowledge or procedural knowledge). When in the learning process is PBL versus group lecture versus on-line learning versus apprenticeship models better modes of learning?  Other contexts: How do we or should we create a medical curriculum that best addresses population health challenges (now and in the future)? What are the gaps between current health challenges and current curriculum?  What vision do we have of healthcare teams?  What evaluation framework and set of metrics should be used to measure "success" or inform changes in medical education. How do we more effectively integrate high quality research across different domains to inform what we should be teaching and how we should teaching to improve medical education?  Sorry more questions than answers in this response.

I was pleased to see Marc White's questions since I was otherwise going to ask Mohan Lai to clarify the original query:  "In the past few decades, there have been a lot of changes occurring in teaching and learning worldwide. The bombardment of information about every subject leads to theoretical knowledge, but very little knowledge is applied to actions  How can we use evidence-based research in medical education?"  

The first several answers seem address the use of medical evidence in curricular materials for learners; whereas, Marc White begins to get into the use of evidence about learning for designing curriculum and guiding faculty development programs and teaching.  Both are important, but I believe the second is more important.  Why?

Since Flexner and the influence he had on medical education over 100 years ago which in turn was based on what had started in Germany and other parts of Europe in the mid-nineteenth century, it has been recognized that medical education should be based on science.  Initially that involved teaching medical students "basic sciences" and subsequently exposing them to clinical medicine.  More recently it has been recognized that science and medical evidence should be integrated with learning about clinical medicine.  As this recognition has grown, I believe there also has been growing recognition that we are missing important pieces of medical evidence to build into our curricula and, of course, into clinical decision-making and care.  Although Enric Aragones points out in his answer that RCTs and meta-analyses (presumably of several RCTs on the same subject) are the gold standard of evidence, they raise some important problems.  In an era of "big data", I think we will begin to see more clinical evidence applicable to individual patients or small groups of patients being generated from large clinical databases that incorporate outcomes data (I began to hope to see this over 20 years ago - see attached article).  

What is exciting now, as alluded to by Marc White, is that theories about how adults best learn have been developed over the past several decades and there now is some evidence to support various aspects of these theories.  The evidence is slowly but surely making its way into the nature of medical and other health professional educational curricula and into the ways budding health professionals are taught.  Curricula are beginning to be based on competences that learners need to acquire not just knowledge that needs to be assimilated.  In an era in which medical evidence is accumulating at incredible rates, it is now understood that learners cannot absorb and retain everything they might need to know/use in their professional lives but are going to have to be competent at acquiring knowledge and new skills as they need them throughout their professional lifetimes.  

The health researchers should involve their target research group/patients in order to select need based research area by themselves along with researcher. The outcome of research should be informed to target group/patients for practical action. The involvement of both researcher as well as target groups in reseach is more practical and evidence based.

Thanks for responding to the above cited question. My main objective to put this question is how we can use various evidence based methodology to improve the medical education, which requires more practical knowledge than the theoretical. Here we can apply to problem based learning or participatory learning for action,etc.This can also be through showing results of operational research.

        Evidence based clinical practices can improve medical education, through Simulation. This has been done for years using clinical experts to develop a simulated clinical practice using current research data to support the educational development. Once the clinical practice is developed, Simulation Centers will support the developed clinical practice for the purpose of medical education. 

       As Simulation Centers continues to grow, nursing / medical education also continues to grow, where clinical competencies are developed, integrated thru Simulation, and safely taught and practiced in support of health care management.

Dr. Grace DNP, PNP

Dear  Mohan

Thank you for your reflexion