Evidence-based psychiatry: a practical approach

Evidence-based journal clubs and the Critical Review Paper

The Critical Review Paper (CRP) has been part of the MRCPsych Part II examination for only two sittings and is still fairly uncharted territory. As two people who have separately sat the two papers, we examine whether evidence-based journal clubs (EBJCs) are useful preparation for the exams. We make an argument for changing the format of journal clubs to make them more relevant to the exam, as well as to promote the development of evidence-based practice.

Psychiatrists' views of evidence-based psychiatric practice

Aims and method

To determine the attitudes of psychiatrists towards the practice of evidence-based medicine by use of a postal questionnaire. A survey was sent to Consultant Psychiatrists and to Higher Trainees in Psychiatry in the West of Scotland Region.

Results

While older influences on decision-making such as tradition and deference still play a part, almost all respondents consider the adoption of more effective care based on best available external evidence desirable; most think it attainable. The technology is generally available, but further training is desired to access the information and its critical analysis.

Clinical implications

Educational activities should increasingly focus on skills for data search and critical analysis.

Evaluating qualitative papers in a multidisciplinary evidence-based journal club: a pilot study

Journal clubs have traditionally been important means by which clinicians, academics and trainees appraise research that relates to their field. In recent years the evidence-based style has become more prevalent, allowing knowledge gleaned from research to be applied to clinical situations. Currently, the main approach of evidence-based journal clubs is quantitative. This paper describes the evaluation of a modified journal club format, developed in an academic department of a medical school and combining the appraisal of both qualitative and quantitative papers.

The case against "the evidence": a different perspective on evidence-based medicine

BACKGROUND

An evidenced-based approach to psychiatry is playing an increasingly prominent role in treatment decision-making for individual patients and for populations. Many doctors are now critical of the emphasis being placed on "the evidence" and concerned that clinical practice will become more constrained.

AIMS

To demonstrate that evidence-based medicine is not new, sources of evidence are limited and psychosocial aspects of medicine are neglected in this process.

METHOD

Some of the literature is reviewed. Ideas and arguments are synthesised into a critical commentary.

RESULTS

These are considered under four headings: evidence-based medicine is not new; what evidence is acceptable; the doctor as therapist; and the emergence of a new utilitarian orthodoxy.

CONCLUSIONS

It is agreed that a degree of professional consensus is necessary. However, too great an emphasis on evidence-based medicine oversimplifies the complex and interpersonal nature of clinical care.