Optometric Education ASCOTECH Volume 25, Number 3 Evidence-Based Optometric Practice and Education William M. Dell, O.D., M.P.H. Optometric practice continues to change. Some of what we practice today is not based on sound evidence. We continue to face an exploding volume of literature, rapid introduction of new technologies, deepening concern about growing health care costs, and increasing attention to the quality and outcomes of health care. One change occurring in medical practice today is in the way in which clinicians evaluate and use the medical literature to more effectively guide physician practice. This shift is so profound as to appropriately be labeled a paradigm shift. The foundation for this shift lies in the advances in clinical research over the last 30 years and the need to demonstrate clinical efficacy in both diagnostic and treatment protocols by the use of randomized clinical trials. This new paradigm is known as evidence-based medicine. For optometric practice, we would, instead, employ the term, "evidence-based optometry." This new philosophy is based on an awareness of the limitations of traditional determinants of clinical decisions and deals with the uncertainties of clinical practice. The shift to evidenced-based practice de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision-making. It stresses the examination of evidence from carefully-controlled clinical research and introduces the need to include in our optometric educational process new skills required of the optometrist. These skills include efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature. Integrating external evidence with daily clinical experience caring for patients, and applying the results judiciously is one of evidenced-based optometry's greatest challenges. As optometric educators, it is obvious that we need to keep abreast of these technological changes and how they impact our institution and how we teach, deliver and model patient care. This column in Optometric Education is dedicated to that task. My erstwhile colleague, Dominick Maino, OD, M.Ed., professor, Illinois College of Optometry, and I will attempt to inform you and, just as importantly, stimulate your own interest in the various areas of technology that we will address. The column will present three to five abstracts on a particular subject matter (e.g. distance education; telemedicine; asynchronous learning; computer laboratories; educational assessment, etc.) and will be preceded by an introduction and followed by a concluding summary. Dr. Maino and I will alternate issues as lead columnist but we will collaborate on each issue. Today's optometric graduates must be educated in how to access, evaluate and interpret the optometric and medical literature. These skills include proposals to apply the principles of epidemiology to day-to-day clinical practice. More and more journals have adopted a more informative style of abstract presentation in which the study design and methods receive greater emphasis. Practice guidelines based on rigorous methodological review of the available evidence are becoming increasingly common. Does evidence-based practice improve patient outcomes? The answer to this question is, in essence, the "proof of the pudding" for this new paradigm. Unfortunately, the proof is no more achievable for the new paradigm than it is for the old as there are no long-term randomized trials of traditional and evidenced-based medical education. There are a few short-term studies, however, that seem to indicate that the teaching of evidence-based practice may help graduates stay up to date, a critical element in the quality of care. The purpose of this article is not to present a formal and thorough review of evidence-based practice but rather to introduce the concepts to the reader. Evidence-based optometry will require new skills for the optometrist, skills which our schools and colleges of optometry should be equipped to teach. While strategies for inculcating the principles of evidence-based optometry remain to be refined, initial experience has revealed a number of effective approaches. Incorporating these practices into optometric education will result in more rapid dissemination and integration of the new paradigm into optometric practice. In concert with the overlying technology theme of this column, the reader is directed to on-line resources for further immersion in the subject. Following is a list, intentionally not exhaustive, of web sites related to the teaching and practice of evidence-based medicine/optometry. Explore! 1. National Guideline
Clearinghouse™ (NGC), a public resource for evidence-based clinical
practice guidelines. NGC is sponsored by the Agency for Healthcare Research
and Quality (formerly the Agency for Health Care Policy and Research)
in partnership with the American Medical Association and the American
Association of Health Plans 2. An Introduction
to Information Mastery 3.How to Read a
Medical Journal Article, by Steve Simon 4. Evidence-Based
Medicine: What It Is, and What Is Isn't 5. Centre for
Evidenced Based Medicine 6. CASP - Critical
Appraisal Skills Programme 7. Centre for Clincial
Effectiveness 8. The Cochrane
Collaboration:Eyes and Vision Group 9. Evidenced Based
Medicine Toolkit 10. How to Teach
Evidence-based Clinical Practice, 2000 11. Evidence-Based
Medicine Reviews 12. Medical SmartSearch
Contact with Your
Ideas: |
|
Home | About ASCO | On-line Registration for OAT | Student
& Advisor Info | Faculty
Meetings | Publications & Reports | Residencies | Search Corporate Contributors | Links | Disclaimer |