Written by guest blogger Manuel Magalhães Sant’Ana.
When you take your pet to the veterinarian, you expect that they will provide the most effective care for your animal. After all, the goal of veterinary education is to teach future veterinarians to critically evaluate and incorporate scientific information into clinical decision-making, right? Well, sort of. Historically, veterinary educators believed that their personal clinical experience was not only valid but necessary for teaching students clinical reasoning skills. Students would rely on empirical data, usually from textbooks, narrative reviews, and clinical case reports, to learn about the most recent breakthroughs in veterinary science. The only abilities required to judge the published literature were medical knowledge and common sense, and those most skilled in using empirical evidence to address practical problems were considered good vets. Especially if they were able to replicate precisely what they were taught.
Following in the footsteps of human medicine, the veterinary profession has evolved tremendously in the last few decades. Many treatments once assumed to be gold standard are now considered to be as ineffective as bleaches, setons, and bloodletting. We know that based on the systematic appraisal of the quality of scientific literature, a tenet of what has become known as evidence-based medicine (EBM). We also know that the evidence supporting complementary and alternative veterinary therapies, such as acupuncture, homeopathy, and osteopathy is untrustworthy due to the low quality of its research (and, in the case of chiropractic, almost non-existent). EBM represents a paradigm shift in how science and scientific education are approached. EBM acknowledges that personal clinical experience can be deceiving. Rather than seeking a therapeutic outcome, EBM considers how the placebo effect can help explain a certain clinical finding. EBM looks beyond the experimental design to explore the limitations and cognitive biases that may be involved in medical research. EBM does not accept a single clinical finding as proof of efficacy, but rather constantly revises the existing evidence through systematic reviews, meta-analyses, and evidence synthesis. The EviEdVet project aims to promote the teaching of EBM and to contribute to the systematic appraisal of the available evidence in veterinary practice. Our research investigated published curricula to determine whether Portuguese veterinary schools have adapted to the EBM paradigm shift. We found that the teaching mostly promotes the role of empirical experience. We also found that alternative therapies are taught as if they were scientifically valid practices. These findings emphasize the need for more focused and targeted instruction on EBM-related topics, particularly with regard to critically evaluating scientific literature and incorporating the best available evidence into clinical decision-making.
Veterinary schools need to rethink the training of clinical reasoning skills because good veterinarians do not necessarily practice what they were taught. Good veterinarians are those who can gather, interpret, and assess the quality of scientific information. They then apply that understanding to clinical practice for the benefit of individual animals.
DR. MANUEL MAGALHÃES-SANT’ANA, DVM, MSc, PhD, Dip. ECAWBM (AWSEL) is a veterinary educator and EBVS® European Veterinary Specialist in Animal Welfare Science, Ethics and Law. He was a Newman Fellow in Veterinary Ethics at the School of Veterinary Medicine, University College Dublin, Ireland. He is currently a research fellow at the Faculty of Veterinary Medicine, University of Lisbon, Portugal, and responsible for the EviEdVet project, aimed at promoting education and training for evidence-based veterinary medicine. He has wide research interests, including the teaching of animal welfare and ethics, the regulation of the veterinary profession, the human-animal bond, the history of veterinary medicine, and evidence-based medicine.
“Teaching Evidence-Based Medicine and Non-conventional (Alternative) Therapies in Portuguese Veterinary Schools—A Curricular Assessment” was published advance access in the Journal of Veterinary Medical Education and is Free to Read until September 23, 2024.
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