Dr Martin Dawes, Director of the Centre for Evidence Based Medicine

The NHS R&D Centre for Evidence-Based Medicine was opened at the John Radcliffe Hospital in Oxford in March 1995. It was set up initially with funding from Central NHS Research & Development, later supported by a regional grant from Oxford & Anglia R&D (now South Eastern NHS R&D).

The remit of the Centre has been twofold. The first remit was to promote the teaching and practice of evidence-based health care (EBHC) throughout the UK.

In pursuing this remit, and recognising at the outset that there were very few EBHC educational resources, its members have:

Produced six textbooks and a series of manuals on how to practise and teach EBHC

Collaborated in the creation of books in evidence-based clinical practice originating outside the Centre. One of these, Evidence-Based Cardiology, includes explicit 'levels of evidence' at the start of each chapter and denotes the quality of evidence on which each clinical recommendation is based

Produced chapters on EBHC for more than a dozen others (including the Oxford Textbooks of both medicine and surgery)
Launched four EBHC journals including Evidence-Based Medicine

Created, developed and maintained a CEBM website (http://cebm.jr2.ox.ac.uk) with interconnected websites containing both educational and immediately clinically applicable resources (which collectively now average more than 60000 'hits' per week)

Created and launched educational programmes in EBHC for undergraduate students and postgraduateAtrainees in medicine, surgery, paediatrics, obstetrics and gynaecology, psychiatry, general practice, nursing, and midwifery
Established a nationwide consortium of workshops in how to practise and teach EBHC, which have assisted members and others to carry out more than 30 local and national workshops involving more than 5000 participants
Participated in the creation of other EBHC Centres in mental health, child health, pathology, dentistry, surgery, nursing, and a Unit for Evidence Based Practice and Policy
Tested paper-based, computer-based, and radio-linked methods for bringing evidence into the daily working rounds of busy clinical teams
Conducted and assisted in audits of the extent to which patients were receiving evidence-based care in medicine, surgery, psychiatry, paediatrics, and general practice
Created, produced and distributed more than 400 copies of user-friendly computer software (the 'CATMaker') for critically appraising the clinical literature
Created, run, and maintained an email discussion group (evidence-based-health) of more than 1600 subscribers, devoted to the exchange of information about the practice of EBHC.
Figure 1: Centre for Evidence-Based Medicine home page
cebm web page

Although the geographic focus of the Centre has been the UK, the practice and teaching of EBHC have spread rapidly across continental Europe, the Middle East, Africa, Australasia, North & South America, and the Far East, and we have been drawn into these developments.

One of our textbooks is published in five languages and another in two. One of our journals is published in five languages. Through the Workshop Consortium, we have 'taught the teachers' of more than 25 countries, and they are now conducting at least 15 workshops a year outside the UK.

Thus the Centre has been instrumental in producing a vast wealth of literature on EBHC. So much has happened in 5 years that attitudes to EBHC were formerly very negative. It is largely due to the enthusiasm and success of the 300 members of the Centre that the place of EBHC has been firmly established in this and other countries.

These members are keen individuals from all backgrounds in the health service and from all levels of each profession. There is no restriction on becoming a member – anyone in the health service can join.

The second remit of the Centre was to produce a formal graduate education programme in the conduct of randomised controlled trials and systematic reviews at the University of Oxford.

In pursuit of this remit, and because there were no 'taught' courses in EBHC research methods in Oxford when the Centre opened, its members have participated in the design and running of two graduate-level educational programmes in EBHC:

A 3-year, part-time Certificate, Diploma, and MSc programme in EBHC administered by the Department of Continuing Education at the University of Oxford.

This course is in high demand, and the first cohort of 24 students has now completed the 3rd-year MSc level modules. It takes graduates from all parts of the health service throughout the world.

Half the candidates continue after completing the first-year 'Certificate' course to complete the second-year Diploma and third-year Masters. These tend to be candidates who are pursuing an academic career. The other candidates want to know more /bout EBHC in an academic environment.

The three main modules of the Certificate are: finding and appraising research; teaching EBHC; and achieving change.

A 1-year, full-time MSc in Randomised Trials and Systematic Reviews, which is being piloted this year as a joint venture of the Departments of Psychiatry and Clinical Medicine and the Centres for Statistics in Medicine and Evidence-Based Medicine.

The Centre is run by a Director, a Centre Manager, a Knowledge Manager and an Administrative Assistant. However, it hs the work of the members in supporting the teaching, research and development that makes the Centre.

In addition, there are individuals who are given Fellowships by the Centre and work there on various projects.

With 1000 new articles being placed on Medline per day, the task of keeping up to date gets more difficult. ähe increasing complexity of diagnoses and therapies make it impossible for physicians to know, at all times, everything they need in order to practise effective medicine.

The most common problems facing a doctor trying to gain knowledge are the time taken to access the information and the difficulty in appraising this information.

Structured abstracts have made the process easier. Over the past 30 years structured abstracts have helped the physician considerably in the speed with which they can isolate the important features of a study. However, the validity of the paper is often not included in the abstract. The numerical analysis may not include key features and often the titles are confusing.

Critically Appraised Topics (CATs) have been developed over the past 5 years (Journal of Evidence Based Medicine) and have the benefit of a structured format covering not only the results of the study but also the validity.

This project has been set up by two doctors to respond directly to the problems facing doctors who are on call. Called Evidence Based On Call (EBOC) it is designed to give short evidence-based answers to the most common and important problems facing doctors on call.

Two Fellows from the CEBM (Dr Bob Phillips and Dr Chris Ball) take a topic and perform a literature search. They then select the articles they want to appraise and, using software written especially for the purpose, produce a CAT. This forms the building block of the knowledge base. Information from these CATs are then pulled together to form a chapter of the EBOC book.

To give you some idea of the scope of this project the EBOC team (four CAT authors in addition to the project leaders) have completed 1600 CATs. This book, which will be in electronic format as well as paper, allows the reader to access the knowledge immediately and to see what sort of quality research the knowledge came from.

The Centre is undertaking many other projects as well as research into how and when we need knowledge during our clinical work, and actively seeking funding to ensure its long-term future and the future of medical knowledge management for tomorrow's health professionals.

CENTRE FOR EVIDENCE-BASED MEDICINE
Set up March 1995
Objectives To promote the teaching and practice of evidence-based health care throughout the UK, and to produce a formal graduate education programme in the conduct of randomised controlled trials and systematic reviews at the University of Oxford
Funding Initially Central NHS R&D funding, later supported by a regional grant from Oxford & Anglia R&D (now South Eastern NHS R&D)
Key personnel Director of the Centre: Dr Martin Dawes
  Centre and Editorial Manager: Mrs Olive Goddard
  Programme Manager: Mr Douglas Badenoch
  Administrative Assistant: Mrs Bridget Burchell
Contact details Address: University of Oxford, Nuffield Dept of Clinical Medicine, Level 5, The Oxford Radcliffe NHS Trust, Headington, Oxford OX3 9DV
  Tel: 01865 222941
  Fax: 01865 222901
  E-mail: oliveg@cebm.jr2.ox.ac.uk
  Website: http://cebm.jr2.ox.ac.uk

 

Guidelines in Practice, April 2000, Volume 3
© 2000 MGP Ltd
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