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

作者：Altamirano Bustamante Myriam M; Altamirano Bustamante Nelly F; Lifshitz Alberto; Mora Magana Ignacio; de Hoyos Adalberto; Teresa Avila Osorio Maria; Quintana Vargas Silvia; Aguirre Jorge A; Mendez Jorge; Murata Chiharu; Nava Diosdado Rodrigo; Martinez Gonzalez Oscar; Calleja Elisa; Vargas Raul; Manuel Mejia Arangure Juan; Cortez Dominguez Araceli; Vedrenne Gutierrez Fernand; Sueiras Perla; Garduno Juan; Islas Andrade Sergio; Salamanca Fabio; Kumate Rodriguez Jesus

来源：BMC Medicine, 2013, 11: 39.

DOI：10.1186/1741-7015-11-39

• clinical ethics
• values
• continuing medical education
• concurrent triangulation strategy
• axiology

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. %26lt;br%26gt;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%26apos;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. %26lt;br%26gt;Results: The healthcare personnel%26apos;s core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P %26lt; 0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P %26lt;= 0.0001). Utilitarian autonomy was reinforced in the participants (P %26lt;= 0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P %26lt; 0.000), self-transcendence (ST) (P %26lt; 0.001), and self-enhancement (SE) (P %26lt; 0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively. %26lt;br%26gt;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.

• 出版日期2013-2-15