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Evidence-based clinical practice education in cerebrovascular disease.

An evidence-to-practice gap exists in stroke. Evidence-based clinical practice (EBCP) education may serve a role in overcoming this gap. EBCP training curricula belong in residency, fellowship, and continuing medical education programs. Examples of successful EBCP curricula already exist, replacing more traditional journal clubs. This brief review emphasizes how EBCP education can be integrated into stroke training and how it fits into the Accreditation Council for Graduate Medical Education core competencies.

Although there has been an explosive growth in the design, conduct, and publication of clinical research in cerebrovascular disease, there continues to be an under- and inappropriate utilization of already existing and new evidence at the patient’s bedside. Numerous examples of this evidence-to-practice gap in stroke exist. Tissue plasminogen activator is estimated to be used in only 2% of all ischemic stroke patients in North America.1 Fifty percent of American neurologists continue to use intravenous heparin for acute stroke in the face of evidence of nonefficacy and harm.2 Fifteen percent of carotid endarterectomies are still performed for inappropriate indications.3 Adherence to evidence-based secondary stroke prevention strategies is generally low: 53% for antithrombotic therapy, 42% for hyperlipidemia treatment, 40% for use of warfarin in atrial fibrillation, 27% for hypertension control, and 18% for dedicated stroke units.4 Although the reasons behind the evidence-to-practice gap are multiple, variable, and complex, education in evidence-based cerebrovascular disease is a valuable tool in a global effort to bridge this gap and provide better overall care to stroke patients.

The primary objective of education in evidence-based clinical practice is to provide a physician with the requisite skills to satisfactorily solve real everyday clinical problems throughout a career—the skills of lifelong self-teaching and learning—and to translate those solutions into better care for patients.

The necessary steps are satisfactorily summarized here5: …