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Evidence-based medicine: clinicians are taught to say it but not taught to think it
  1. R Scott Braithwaite
  1. Correspondence to Dr R Scott Braithwaite, Department of Population Health, New York University School of Medicine, New York NY 10016, USA; scott.braithwaite{at}

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Preparing for my decennial recertification exam in internal medicine opened my eyes to a startling disconnect in how evidence-based medicine (EBM) is communicated to practising clinicians compared with how it is implemented by expert panels and EBM authorities. Indeed, sources of continuing clinical education often omit basic tenets of EBM, in particular how to integrate the best available evidence with clinical expertise.1–3 This disconnect is mystifying: why should education experts well versed in EBM use communication templates disjointed from EBM to communicate evidence for practising medicine? For example, a common source of preparation for the American Board of Internal Medicine recertification exam is the Medical Knowledge Self-Assessment Program (MKSAP) published by the American College of Physicians.4 Even though the American College of Physicians prioritises the mission of teaching and implementing EBM,5 two advisements from the 2017 MKSAP illustrate how the curriculum they sponsor deviates from this mission.


Advisement 1: ‘Routine screening for skin cancer using a total body skin examination is not recommended. The United States Preventive Services Task Force (USPSTF) found insufficient evidence that routine skin examination was effective at reducing the morbidity and mortality from cutaneous melanoma, basal cell carcinoma, or squamous cell carcinoma. Patients with high cumulative levels of sun exposure should be encouraged to wear sunscreen and protective clothing, although the benefit of such counselling is unknown.’

Here, clinicians are not told whether the advisement’s basis in EBM is because there is no direct evidence or because there is direct …

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