Embracing evidence-based medicine - Veterinary Practice
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Embracing evidence-based medicine

Could an evidence-based approach to veterinary medicine help vets to outplay “Dr Google”?

Evidence-based veterinary medicine is described as the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstance (Straus et al., 2005).

If you are anything like me, you will view the concept of evidence-based veterinary medicine (EBVM hereafter) with fluctuating fits of enthused interest and guilt-ridden exasperation. The former comes from the knowledge that EBVM helps us “do better”, and a keenness in knowing that it’s a timely topic which will shape the veterinary world of tomorrow. The latter sentiment is borne of the awareness that perhaps this is the way I should always have conducted my work, searching even harder to always use the right information to make the best choices, and to remove all traces of subjectivity from those two words. With this comes hard work, and the resources I’m not sure I possess, hence the exasperation.

This article incorporates some reflections which will balance these considerations, and make a case for how we might find an ever-stronger answer to the “what’s in it for me?” question, particularly in the age of “Dr Google” and apparent attrition in the value of expert opinion in the eyes of pet owners.

We are rational people

I feel we have little to worry about when it comes to integrating EBVM into practice. Approaching clinical work with a critical mindset and balancing scientific truths with working pragmatism underpins much of the work I see being done both in practice and within industry. Vets and nurses are implicitly trained to make decisions based on what we know works. The culture shift to

FIGURE 1 Steps of evidence-based veterinary medicine (adapted from Schmidt et al., 2007)

complete integration entails our follow-through on the internal challenges (which some may frame as healthy scepticism, some as downright doubt) we face.

It is about taking time to answer the question: “Will this make a difference to the life I’m helping to manage?” to the very best of our ability. For me, as I learn more about the topic, EBVM is shaping up to be the structure by which I can have more conviction in the recommendations I make and a source of confidence in the rationale I have used to come to a decision.

Learn through doing

The 70:20:10 model for learning and development, most often referred to in management circles, states that a learner best develops new skills through 70 percent learning through doing, 20 percent learning from others and 10 percent via formal, written or presented materials, such as text books and CPD courses. This workplace learning approach can certainly be applied in veterinary practice, particularly when learning EBVM.

Undertaking the five steps summarised in Figure 1 (detailed guidance can be found in the EBVM Network’s learning tutorial) to find a well-researched bottom-line conclusion to a tangible clinical question is an irreplaceable learning experience. The tangible benefits from this include not only optimised patient outcomes and client satisfaction, but the development of improved practice protocols, business gains and staff engagement. As a learner, you will acclimatise yourself to dealing with evidence, particularly facing the unique challenges of retrieval and access within the veterinary sphere, but also the critiquing process, which is essential to evidence appraisal before in-practice changes are embarked upon.

Take the next step

At a business management event I recently attended, the panellists were asked, “What will the veterinary profession of the future look like?” Replies calling out vets’ imperviousness to change and risk aversion, alongside Brexit uncertainties and shifting expectations towards greater individualisation in pet care were given, but most attention was paid to the reality of technology changing the way we practise. Many are anxious about the loss of trade to e-commerce and unsure about how to capitalise on the connectivity that the internet offers.

In the UK, Google was the most nominated go-to electronic resource among 3,572 veterinary professionals undertaking an online questionnaire (Neilsen et al., 2015).

We are plainly in the same league as our clients in using this resource to find evidence. Our point of difference is a working understanding of proven models to judge the quality of that evidence, and to find more of it, from reliable platforms. We can offer perspective and demonstrate how unreliable Google search results are. I can’t help but wonder if EBVM skills should be proactively communicated by vets and nurses, to increase our value as experts.

Increased engagement in EBVM is also a product of the computer age. We all have the technology to digitise our interactions right by our sides, most hours of the day. By this I mean that we have all realised the value of creating digital records – of storing information and interactions in electronic format which will make our lives easier, and then transferring and transforming it to clinically significant data.

Not only are we given the gift of online access to evidence, we can create it of our own accord. Insights from clinic-based research such as the offerings of VetCompass and SAVSNET, as well as easy access to applicable evidence syntheses such as BestBETS for Vets (Figure 2), can be communicated as a value-add to pet owners, as markers that we are a future-embracing profession. Making clear that our recommendations come from an evidence base should drive greater client compliance.

Don’t miss out on a good thing While the RCVS now lists “How to evaluate evidence” as a day one competence, veterinary educators are making

FIGURE 2 BestBETS for Vets is a readily available evidence hub for busy vets and nurses

relevant changes to vet and nurse student curriculums. For those of us well beyond our undergraduate years, learning and applying an EBVM approach is a differentiation opportunity for early adopters. It may also be just the ticket for promoting and developing leadership skills in recent graduates. By demonstrating ownership of the shift in thinking and having young “EBVM champions” set a new pace, these colleagues will likely become more engaged with their workplace, and receive often-needed recognition among peers.

Call to action

The ask is to change your mindset if you haven’t already, and accept a culture of evidence-driven practice. Start adapting your personal and the clinic’s way of working, creating a healthy buzz of curiosity and open questionasking. Let the fact that you don’t have answers to so many “why” questions be a motivator, and a catalyst for some of the most important conversations we can have in practice.

Eventually, I would like to see us using technology on both sides of the equation. While the “Acquire” step of our flowchart can be answered by searching online bibliographic databases and many other secondary sources of evidence, we should offer and email the fruits of our evidence searches directly to our clients. The fine details of our search results may not mean much to the owner but they do at least demonstrate the efforts taken in caring for their pets.

Complete transparency of the clinical decision-making process will demonstrate the value of a veterinary professional’s opinion and experience, as well as the ability to standardise and maximise the likelihood that their pet’s health will benefit. With an evidence-based approach, we become the communication specialists who outplay “Dr Google”, and maintain our leadership in pet health.

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