If only I had had S4BE when I was a student…

Posted on 6th December 2013 by Iain Chalmers

I was let down badly by the way that I was taught at medical school fifty years ago. Our teachers handed us down ‘facts’ that they expected us to memorise regurgitate at exam time. One of the problems with this method of ‘teaching’ was that different specialists handed us down conflicting ‘facts’. So, for example, one surgeon would tell us that the only correct treatment for breast cancer was very radical mastectomy, sometimes with oophorectomy and hypophysectomy as well, while another would say that less radical surgery was just as effective.  The key skill we needed at exam time was to try to work out which opinion was held by the examiner in front of us, and to regurgitate his (and it almost always was ‘his’) particular ‘facts’.

But how to make sense of this jungle of conflicting views from different ‘authorities’.  We weren’t encouraged to think critically, to ask what evidence there was to support different ‘facts’, let alone challenge our teachers to explain the factual basis of the conflicting ‘facts’ with which we were being presented.  For example, it wasn’t until six years after I had been let loose on the British public with ‘a licence to kill’ that I happened upon the notion of a controlled trial to find out which opinions about treatment were more likely to be correct.

I am sure that things have changed a lot since my days as a medical student, but that’s no reason to imagine that all is well. Eminence-based health care still often trumps evidence-based health care. This is why ‘Students for Best Evidence – S4BE – is such a welcome new resource. Those of us developing Testing Treatments interactive (www.testingtreatments.org) look forward to working with S4BE to develop and link to useful resources for students in the healthcare professions.  Together we will try to help ensure that all health care professionals know how to recognise when there are important uncertainties about whether their treatments are doing more good than harm, and their responsibility to contribute to research to reduce the uncertainties. Patients deserve no less from those to whom they turn for help.

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