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. 1999 Jan 30;318(7179):331.

Implementing research findings in developing countries

Skills for appraising evidence must be taught

Alison Hill 1,2,3, Katie Enock 1,2,3, Catherine Brogan 1,2,3
PMCID: PMC1114796  PMID: 9924075

Editor—The paper on implementing research findings in developing countries sets out a clear framework for getting research findings into practice.1 With the creation of systematic reviews and guidelines, and implementation programmes through workshops and published work, the framework is in line with the process in Western countries. However, one element that we would add is the development of skills to find and appraise the scientific evidence.

We know that on its own the dissemination of guidelines and other educational materials has only a small impact on practice2 and that approaches have to be multifaceted to work. Yet for many parts of the developing world access to evidence will be through literature in one form or another, and there may be little opportunity for getting together with colleagues.

This means that the acquisition of skills to find and appraise evidence must be central to all programmes designed to help get research into practice. Even in the United Kingdom many clinical staff have not got the basic skills in finding and appraising evidence, and this is now being remedied through comprehensive educational programmes in many parts of the country. To ensure clinicians are equipped with skills to find and appraise evidence is an enormous challenge for developing countries, but it has to be tackled. Methods will have to be tailored to the particular needs of clinicians in developing countries and no doubt have to include distance learning techniques.

References

  • 1.Garner P, Kale R, Dickson R, Dans T, Salinas R. Implementing research findings in developing countries. BMJ. 1998;317:531–535. doi: 10.1136/bmj.317.7157.531. . (22 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Freemantle N, Harvey EL, Wolf F, Grimshaw JM, Grilli R, Bero LA. Printed educational materials to improve the behaviour of healthcare professionals and patient outcomes. In: Cochrane Collaboration. Cochrane Library. Issue 3. Oxford: Update Software, 1998.
BMJ. 1999 Jan 30;318(7179):331.

Medical curriculums need changing

Trevor Gibbs 1

Editor—Few people who have worked in developing countries would argue with Garner et al’s summary of how to encourage research in such areas and the difficulties and obstacles encountered.1-1 However, experience from Ukraine shows that the solution may not just be providing the finance but may lie deeper in basic medical education.

The Royal College of General Practitioners has been working, through its international fellowship programme, on the facilitation of a system of primary care in Ukraine that is based on the European model. This programme is now in its fourth year, and substantial progress has been made.1-2 We have been able to observe the delivery of health care, and although the numbers are small, interesting observations are emerging which may affect long term planning.

Observation of consultations in primary care suggests that there is a strong tendency to medicalise non-clinical problems. Multidrug prescribing is often the rule, and health promotion is rarely discussed. Neither the undergraduate nor the postgraduate medical curriculums teach health promotion or the diagnosis and management of psychosocial disorders (unpublished data). This has to be taken into the context of Ukraine having the worst morbidity and mortality figures in the whole of eastern Europe, with most illness being a result of a poor understanding of personal and social effects on disease.1-3

Ukraine is ready for the introduction of primary care research and evidence based medicine, but this must be accompanied by a change in medical education. This change has to be driven by a central government order with its associated complexities.

Ukraine shares with other developing countries the perception that a good doctor is judged by the items of equipment and number of tests he or she performs. Hence computers are becoming increasingly common in medical practices and should be accessible for research. However, since there are no educational initiatives to encourage the wider use of information technology, specifically to access data or to collect data, facilities are unused and become items of status rather than practicality. Medical staff must recognise that this deficiency in basic medical education will impede the development of standard and progressive medical care and research, even if accompanied by vast financial resources.

References

  • 1-1.Garner P, Kale R, Dickson R, Dans T, Salinas R. Implementing research findings in developing countries. BMJ. 1998;317:531–535. doi: 10.1136/bmj.317.7157.531. . (22 August.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Gibbs T, Mulka O, Zaremba E. The Royal College of General Practitioners Ukraine fellowship programme 1993-1997. Eur J Gen Pract. 1998;4:84–87. [Google Scholar]
  • 1-3.Kromhout D, Bloemberg B, Doornbos G. Reversibility of rise in Russian mortality rates. Lancet. 1997;350:379. doi: 10.1016/S0140-6736(05)64128-1. [DOI] [PubMed] [Google Scholar]

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