Gap Between Practices of Evidence-based Medicine and Personalized Medicine: A Barrier in Learning

Date

2021-08

Journal Title

Journal ISSN

Volume Title

Publisher

Abstract

Background: Evidence Based Medicine (EBM) is the use of high-quality clinical research in making decisions about the care of patients. Health professionals have used EBM to guide clinical decision-making for the last three decades. However, critics have suggested that EBM focuses on groups of patients and does not consider the differences between each patient, subgroup analyses, and patient values and preferences. Personalized medicine (PM) is an approach to individualize diagnosis and treatment of diseases through genetic, biomarker, phenotypic, and psychosocial characteristics of an individual patient. Both philosophical approaches have merits as well as limitations. The conflicting priorities between EBM and PM have led to a gap in the practices of medicine and have created an educational barrier for physicians in training. This gap was particularly evident during the COVID-19 pandemic when clinicians were caught by surprise without any strong evidence-based guidelines, and treatment patterns were changing on a day-to-day basis. Purpose: This study aimed to determine the barriers that contribute to the gap between EBM and PM and evaluate its impact of these barriers on the learning of the medical house-staff. The following research questions were asked: 1) What barriers are causing the gap between EBM and PM from the perspective of bedside clinicians? 2) What barriers are impacting the learning of the medical house-staff? Methods: This qualitative study was performed at a large academic tertiary medical center with 45 ACGME accredited programs and 9 GMEC sponsored fellowships. Analytic strategies included interpretive axiology, deductive approach, and hermeneutic phenomenology. After securing Institutional Review Board (IRB) approvals, inclusion and exclusion criteria were established. Non-probability purposive sampling was used. In-depth personal interviews were conducted by phone with bedside clinicians. We reached saturation point after nine interviews of staff who had a total of 177 years of teaching experience. The interviews were conducted with a validated protocol of open-ended leading questions and a probe of clinical case-scenario. Using four Subject Matter Experts (SMEs) with a combined clinical experience of 66 years, instrumentations of validity, reliability, credibility, transferability, dependability, and conformability were utilized to establish the trustworthiness. Data was made secure by encryption. Manual coding was performed from the transcripts. Results: We obtained ten themes. Five barriers were identified causing the gap between EBM and PM, including: 1) design, 2) proposition, 3) financial, 4) leadership, and 5) suboptimal science. In addition, five barriers were identified causing the impact from this gap on house-staff learning including: 1) Electronic Medical Records (EMR), 2) undefined roles, 3) communication, 4) burnout, and 5) attitude. Conclusion: There is an emergent need to address the gap between EBM and PM at various levels to synchronize the function of different paradigms of the practice of medicine. This gap is consequently impacting the learning of the physicians in training. Evaporating trust in the healthcare system can be addressed by removing these barriers to facilitate the learning of the next generation of physicians.

Description

Keywords

Evidence Based Medicine (EBM), Personalized Medicine (PM), Critical thinking, Reflective learning, Medical house-staff, Gap, Barriers

Citation