![]() |
Do you know which literature to consult and how to critically appraise it? |
Dr Nick Royle works for the Royal College of
Veterinary Surgeons in the UK. He took some time out to explain his role and
the nature if evidence-based veterinary medicine (EBVM).
What
is your role within the RCVS?
I’m the Executive Director of RCVS Knowledge.
Formally the “RCVS Trust”, we’re the independent charity partner of the UK’s
Royal College. We have a threefold mission: to manage the College’s Historical
Collection; to maintain and grow a (principally online) technical library on
behalf of the practising veterinary community; and to forward the relatively
new concept of Evidence-based Veterinary medicine (EBVM).
I came to RCVS Knowledge having led TheCochrane Collaboration for nine years as its first CEO, and previously to the
“evidence led” movement from having tried to adopt this approach for drug and
alcohol services in Scotland prisons whilst serving as their first Head of
Addictions.
The role of RCVS Knowledge within EBVM is to
bring together those pockets of activity – and there are some really great
teams out there working on this – and through international networking ensure
that the whole really is greater than the sum of the parts. Together, we can do
something really special.
Dr Nick Royle. |
What,
in a nutshell, is EBVM?
EBVM is the conscious use of best available
evidence to support clinical decision-making. Derived principally from the
synthesised conclusions of the best available scientific evidence, such
evidence should be used in conjunction with the practitioner’s experience, patient
circumstances, and owners’ values.
EBVM
is "new" in veterinary medicine but is it possible that many of us
are already using it without really knowing it?
More than likely, to different degrees. There
are many great vets, and any good vet will be making sure that their decision
making is science-based. But an evidence-based approach takes this to another
level, and is, if you like, a different mindset. Yes, you might have read the
latest paper on the condition – but where did that paper sit within the greater
context of what we know about the condition? Was the trial or study on which it
was based well conducted, free from bias, and of sufficient “power”? So an
evidence-based approach is about being questioning, and open to changing your
practice in the light of your new knowledge.
One
of the problems with evidence in any field of medicine today is that it is
often presented by companies that manufacture or distribute a product, with a
vested interest in its sales. Is some evidence more trustworthy than other
evidence?
Some years back, when I was running a drug
testing programme, a company tried to sell me a urine testing kit. The salesman
provided me with a research paper that he reassured me showed how good his kit
was. I read the paper, and it said that his kit wasn’t as good as other kits
available.
I guess the salesman had never read his own
stuff, and the moral of the story would be that we should always be wary of a
single research paper, and that we need to place such information within the
wider context of what is known about the question being asked.
This is where the type of evidence-based
approach we advocate really pays off. By “evidence” we don’t just mean the
results of a single paper, and we certainly don’t mean compiling a range of
clinical test results. We mean synthesised evidence drawn from the collated
results of all the trials or studies relevant to the question we are asking.
The evidence-based approach has a number of
steps:
- Work out what your question is – the more defined the better.
- Track down the best available evidence – perhaps using the RCVS Knowledge online library (and maybe our information specialists to help).
- Critically appraise the evidence you find. How up-to-date is it; are the trials on which it is founded well conducted; is there any bias in the trials or how they are reported, and is this relevant?
- Apply what you have found to your decision-making process.
- Evaluate how things turned out.
What
does EBVM look like in the context of veterinary general practice, i.e. how
does a practice where vets using EBVM differ from one where they don't?
An evidence-based approach has revolutionised
clinical care in human health. Doctors have stopped doing many things that are
ineffective or dangerous, become more conscious of price differentials between
equally effective products, and through clinical guidelines applied this
knowledge widely throughout their profession. Very often with no idea that they
are being “evidence based”.
We share the view of many within the
veterinary profession that it’s time for a similar “quiet revolution” here.
One of the most difficult questions I am
asked by young vets-in-training is what do they do if they get to their first
practice with all their hard-won knowledge, and find that people aren’t
welcoming of new-fangled ideas and that “they don’t do that here”.
The sign of a good practice is surely one
where the veterinary team are questioning and open to new ideas; where cases
are discussed amongst colleagues, and new concepts considered carefully and
where appropriate embraced. That would be an evidence-based veterinary team.
Thank
you Dr Royle for taking the time to answer our questions. If you’d like to
learn more about EBVM and you’re based in the UK (or plan to pop over there in
the near future), the RCVS Knowledge is running the first EVBM Skills Day:
Essential Tools for Evidence Based Practice.
The program,
which you can view in full here, looks absolutely fantastic.
Topics
covered include how doctors make decisions, how to design a study in practice,
how to critically appraise a paper and run a journal club, significant event
and clinical auditing and evidence-based veterinary management.