Don’t just blame the evidence: considering the role of medical education in the poor uptake of evidence-based medicine in clinical practice

The ‘better evidence for better healthcare manifesto’ recently published in the BMJ considers the importance of generating higher quality research and of ensuring the dissemination of research into relevant, digestible and accessible formats.1 In addition to these important considerations, in order to ‘fix’ evidence-based medicine (EBM) and facilitate evidence-based practice, the strategies currently advocated to teach EBM and the evidence base of the foundational knowledge taught in medical schools need to be addressed. When EBM was originally conceptualised in the 1990s, it was thought that answering questions arising from patient care with the critical appraisal of the primary literature would foster the ‘conscientious, explicit, and judicious use of current best evidence’ in clinical practice.2 In medical schools, this reactive approach to EBM has resulted in the creation of specific ‘EBM curriculum’, either as stand-alone courses or integrated with clinical care, that have focused on the steps of critical appraisal.3 Once ‘trained’, learners have been expected to apply these EBM competencies to address point-of-care questions. However, it was soon pointed out that expecting all practitioners to become enthusiastic consumers of the primary literature was not …