Medicine meets critical thinking
THE formal adoption of Evidence-Based Practice (EBP) as an approach in clinical practice over the past several years has improved the critical thinking and confidence of local health professionals in Brunei.
“A lot of times, we are using EBP because we are trying to improve our communication with the patients. These days, there are a huge amount of options in treatment and diagnosis, for example, and patients are well-informed. Unless the doctor, nurse or health professional facing patients are trained in EBP, they will be at a disadvantage,” said Dr William Chong Chee Fui, Medical Superintendent at the Suri Seri Begawan Hospital.
Chong, an EBP trainer-of-trainers himself, led the 4th EBP Workshop conducted at the hospital last month for 26 health professionals working in Brunei.
According to him, the implementation of EBP is part of the Ministry of Health's drive to improve and provide doctors, nurses and allied health professionals with continued medical education.
The idea was to bring trainers from abroad during the first national workshop in 2010 and to identify participants to be trained as trainers, who would replicate the workshops.
“We have over 500 doctors and several thousand nurses to date, we have only trained about a third of these in EBP,” said the doctor.
In the workshops, participants were trained to be more efficient and quick in locating appropriate journals or academic documentation accessed online.
With the vast amount of information available – over 23 million citations of medical literature in the web's largest search engine, PubMed.
Participants are also taught to identify legitimate and credible resources.
Using the best available external clinical evidence from systematic research, participants are able to confidently recommend diagnosis options and treatment.
A clinician's task is to interpret best current evidence from systematic research in relation to an individual patient, including that individual's preferences, environment, culture, and values regarding health and well-being.
“EBP doesn’t just teach you how to access current literature, but how to assimilate it and use it for our local population… a good example was the gastroenteritis outbreak two months ago,” he said.
“Under the guidance of MoH (Ministry of Health), a group of health professionals looked at current evidence and came up with healthcare guidelines for every hospital to implement… the outbreak has now settled so I'm sure it was a success,” he said.
“The biggest challenge I see is that it will take many more years for everyone in the country to be trained (at the current rate of training). Of course, at each workshop I identify people ready to be trained as trainers to increase our training pool,” continued Dr Chong.
He added that another long-term challenge with EBP was the existing culture and mindset among health professionals, which he explained must be a habit entrenched in all levels of the medical profession.
“You can train people to do it (EBP) but… when they leave the workshop, you must be able to provide an environment for them to be able to use what they practise constantly, daily,” he said.
“If they don't do this, they lose their skills… everybody else must be using it. People at the top must be using it.”
The Brunei Times