Evidence-based medicine and values-based medicine: partners in clinical education as well as in clinical practice

Ed Peile

doi:10.1186/1741-7015-11-40

Abstract

The best clinical decisions are based on both evidence and values in what is known as the 'two-feet principle'. Anecdotally, educationalists find teaching clinicians to become more evidence based is relatively simple in comparison to encouraging them to become more values based. One reason is likely to be the importance of values awareness. As values-based practice is premised on a mutual respect for the diversity of values, clinicians need to develop the skills to ascertain patient values and to get in touch with their own beliefs and preferences in order to understand those at play in any consultation. Only then can shared decision-making processes take place within a shared framework of values. In a research article published in BMC Medicine, Altamirano-Bustamante and colleagues highlight difficulties that clinicians face in getting in touch with their own values. Despite finding that healthcare personnel's core values were honesty and respect, autonomy was initially low ranked by participants. One significant aspect of this work is that this group has demonstrated that the extent to which clinicians value 'autonomy' and 'openness to change' can both be positively influenced by well designed education.

Highlights

Evidence-based medicine (EBM) and values-based medicine (VBM) are complementary partner components of clinical decision making
Altamirano-Bustamante and colleagues talk of the axiological complexity of clinical practice which extends beyond the EBM domain of epistemological values related to ‘describing, explaining or predicting what takes place within the human body’ to the VBM domain of social, political and ethical values acting on ‘the bio-psycho-social spheres of a person and relating to his/her dignity’ [4]
This is the rationale for exploring how a continuing medical education (CME) program impacts on the way in which healthcare workers operate in respect of EBM and VBM

Summary

Introduction

Introduction Evidence-based medicine (EBM) and values-based medicine (VBM) are complementary partner components of clinical decision making. Both at the level of diagnosis and for management of a clinical problem it is important that clinicians can work comfortably and effectively with scientific evidence relevant to patient’s problem, and with the values at play which comprise the patient’s values and the clinician’s values and often those of others such as carers or the healthcare organization [2]. Just as a failure to access the appropriate generalizable scientific evidence can mean that flawed clinical decisions result, so (and perhaps more commonly) a failure to ascertain and work with the values affecting the individual consultation can result in disaster.

Results

Conclusion