Promoting networks between evidence-based medicine and values-based medicine in continuing medical education

BMC Medicine

Alejandro Reyes-Fuentes¹  Jesús Kumate-Rodríguez¹  Fabio Salamanca⁸  Sergio Islas-Andrade⁴  Juan Garduño⁶  Perla Sueiras⁷  Fernand Vedrenne-Gutiérrez⁷  Araceli Cortez-Domínguez²  Juan Manuel Mejía-Arangure^1,10  Raúl Vargas⁷  Elisa Calleja⁷  Oscar Martínez-González⁵  Rodrigo Nava-Diosdado⁷  Chiharu Murata⁹  Jorge Méndez⁷  Jorge A Aguirre²  Silvia Quintana-Vargas²  María Teresa Ávila-Osorio⁷  Adalberto de Hoyos³  Ignacio Mora-Magaña⁹  Alberto Lifshitz⁸  Nelly F Altamirano-Bustamante⁹  Myriam M Altamirano-Bustamante⁴ 

[1] Fundación IMSS, Paseo de la Reforma 476, Mexico 06600, D. F., Mexico;Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro 36000, Guanajuato, Mexico;FES Acatlán, Universidad Nacional Autónoma de México, Av. San Juan Totoltepec, SN, Sta. Cruz Acatlán, 53150, Naucalpan de Juárez, Estado de Mexico, Mexico;Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico;Universidad Anáhuac, México Norte, Av. Universidad Anáhuac 46, Lomas Anáhuac, Huixquilucan 52786, Estado de Mexico, Mexico;Hospital Infantil de México "Federico Gómez", Secretaría de Salud, Dr. Márquez 162, Doctores, Mexico 06720, D.F., Mexico;Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico;Unidad de Educación, Investigación y Políticas de Salud, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico;Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Mexico 04530 D.F., Mexico;Unidad de Investigación en Epidemiología, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico

关键词: axiology;    concurrent triangulation strategy;    continuing medical education;    values;    clinical ethics;   

Others  :  857190
DOI  :  10.1186/1741-7015-11-39

 received in 2012-06-08, accepted in 2013-02-15,  发布年份 2013

【 摘 要 】

Background

In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities.

Methods

A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.

In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice.

Results

The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10^th (order mean (OM) = 8.00) to the 3^rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively.

Conclusions

The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation.

【 授权许可】

   
2013 Altamirano-Bustamante et al; licensee BioMed Central Ltd.

【 图 表 】

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