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Primary care
Building capacity in evidence-based medicine in low-income and middle-income countries: problems and potential solutions
  1. Peter J Gill1,2,
  2. Shabana M Ali3,
  3. Yasmin Elsobky4,5,
  4. Raymond C Okechukwu6,
  5. Tatiane B Ribeiro7,
  6. Augusto Cesar Soares dos Santos Junior8,9,
  7. Daniel Umpierre10,
  8. Georgia C Richards2
  1. 1 Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  3. 3 Ganapathy Clinic, Mumbai, India
  4. 4 El-Galaa Military Medical Complex, Cairo, Egypt
  5. 5 NAPHS Consultancy, Alexandria, Egypt
  6. 6 Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
  7. 7 Department of Preventive Medicine, University of Sao Paulo, Sao Paulo, Brazil
  8. 8 Hospital das Clínicas Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  9. 9 Unimed Belo Horizonte Hospital, Belo Horizonte, Brazil
  10. 10 Instituto de Avaliação de Tecnologia em Saúde (INCT IATS)/Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
  1. Correspondence to Dr Peter J Gill, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto M5G 0A4, Ontario, Canada; peter.gill{at}

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The early era of evidence-based medicine (EBM) saw the emergence of a cohort of leaders who applied the concepts of clinical expertise, best available evidence and patient preferences to healthcare. Yet, with time, these core components of EBM have become distorted, misinterpreted and hijacked.1 The EBM Manifesto provided a roadmap for tackling the core issues related to the practice and application of EBM.2 One of the important items in the manifesto is to ‘Encourage the next generation of leaders in evidence-based medicine’.2 Achieving improvements in healthcare globally requires building and sustaining early and mid-career researchers (EMCRs).3 Yet, there are big gaps in both critical appraisal and research capacity, particularly in low-income and middle-income countries (LMICs), and this hinders development in these regions.4

At the 2019 EBMLive conference (see box 1), we wanted to better understand the problems and challenges that EMCRs encounter. In particular, we focused on EMCRs in those LMICs undergoing major health system transformations, such as Brazil and India. We asked the six recipients of the Building Capacity Bursaries (all co-authors of this commentary) to describe the challenges that they have encountered individually and among their peers, along with potential solutions (see box 2). Their responses reflect healthcare professionals who practice in South America, Africa, the Middle East and Asia. While some challenges are specific to certain settings, we tried to identify, highlight and describe broad overarching themes.

Box 1

The EBMLive Conference

  • The EBMLive conference (, a joint partnership between the Centre for Evidence-Based Medicine and the BMJ, is designed to ‘develop, disseminate, and implement better evidence for better healthcare’. Since its inception, EBMLive has endeavoured to include the voice of students and early career researchers. Manifestations of this policy have included creation of leadership scholarships to …

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