The History and Philosophy of Evidence-Based Health Care

July 14-18, 2014, Oxford, United Kingdom

Why and how did evidence-based medicine arise, and why should you accept it?

The module will trace the historical development of evidence-based health care. Students will be encouraged to think critically. Many famous medical doctors, including Galen, Descartes, and Locke, were also philosophers, and recent evidence suggests that studying humanities improves clinical skills. The critical thinking and debate encouraged throughout the module is a transferable skill that can be used in research and practice. By combining an understanding of the history and philosophy of science, participants will be better informed about their acceptance of evidence-based practice.

The last date for receipt of complete applications is Friday 27th June 2014. Regrettably, late applications cannot be accepted.

Description
Why study the history and philosophy of Evidence-Based Health Care (EBHC)? Become a better health care professional. Medical students who study the humanities perform better than those who focus exclusively on the sciences(Lancet 1996 (347:55-6), J Med Humanities 2004(30:53)).
Learn to think more critically. Critical thinking is a pillar of analytic philosophy. You will be encouraged to question EBHC rather than accept it because it has become widely accepted. Our speakers have included influential critics of EBHC such as Ross Upshur, Professor Nancy Cartwright, Dr Amanda Burls and Professor Rom Harre.
Become a better historian of medicine. The tutors on the course include Professor Ulrich Tröhler, Sir Iain Chalmers and Dr Mike Clarke Turner who will provide accounts of how EBHC arose, so the course is an invaluable case study.

Why choose this course if you are neither a health care practitioner nor a philosopher or historian?. The lay press bombards us with claims that diets will cure disease, that new medical technology promises to prolong life, and that environmental factors will lead to premature death. Because of the interdisciplinary nature of the course, technical jargon particular to each discipline will be either entirely avoided or explained. Hence the course is accessible to anyone interested in understanding the nature, history, and justification for the kinds of health claims they face on a daily basis.
Become a better writer. History and Philosophy of Science involves writing critical essays. The course involves workshops on essay writing and an online peer review process to help you develop your ideas.

There are will also be plenary sessions led by leading experts within the field of EBHC.

Core Reading
Howick J (2011). The Philosophy of Evidence-Based Medicine: a philosophical inquiry. Blackwell-Wiley. Chapters 1-3
Chalmers I. James Lind Library: explaining and illustrating the evolution of fair tests of treatments. www.jameslindlibrary.org
Tröhler U (2000). ‘To improve the evidence of medicine’: the 18th century British origins of a critical approach. Edinburgh: Royal College of Physicians. Available for free download from http://tinyurl.com/9blkdjo
Comments from previous participants:

“The course will help me to structure my thinking about the advantages and limitations of EBM and to answer the questions I have about the interaction between EBM and the structure of current western healthcare systems.”

“Gave me a completely different perspective on EBM. Eg. Being more specific about asking questions, being careful about language and terminology, being aware that non-medical folks look at the issues differently than medical ones, examining how philosophy might fit into my particular work.”

“The content of the program (a very specific program regarding the background of EBM and its interaction with current healthcare systems), just where I was looking for!The luxury of a group of excellent lecturers. It was really nice to be exposed to such an enormous degree of expertise and inspiring idea’s about EBM and healthcare! And that during a whole weekThe diversity of participants (countries, backgrounds, idea’s).”

Programme details
Session topics
-An introduction to the history and philosophy of EBHC
-The introduction of quantification in assessing treatment effects
-The introduction of systematic reviews (evidence synthesis)
-The introduction of measures to ensure that like will be compared with like in treatment comparisons
-The history of blinding/masking to reduce observer biases
-Examining critiques of the EBHC stance on ‘pathophysiologic rationale’
-The philosophy of blinding/masking those involved in testing treatments
-Examination of arguments that average results are of questionable relevance to individuals
-The history of probabilistic thinking and statistical analysis in testing treatments
-What role does the sociology of science play?
-What are the explicit (and hidden) ways in which values come into (or should come into) EBHC?
-Views from the wild: applying philosophy of EBHC in actual health care practice

Staff
Dr Jeremy Howick
Role: Module Coordinator
Jeremy Howick is the MSc in Evidence-Based Health Care Dissertation Coordinator and NSPCR…more

Course aims
By the end of the course students will be able to:
-explain key philosophical concepts (‘epistemology’, ‘ontology’, ‘value theory’)
-defend and critique EBHC
-compare different historical approaches to understanding the origins of EBHC (quantification, the evolution of measures to reduce biases, statistical analysis of treatment tests)
-think critically
-write a philosophical or historical essay

Assessment methods
Students who wish to take the course for credit will be expected to write an extended essay of no more than 4000 words to a standard suitable for submission to a peer-reviewed journal. In this, students will be expected to explore, in depth, one aspect of the history and/or philosophy of EBHC. Essay topics will be chosen from a list (see below). Tutors from the course will supervise this work, and students will also act as peer reviewers and editors. Together with their supervisors, students will be encouraged to submit their essays to peer-reviewed journals.

The content and assignment for the module will be at a level that would be sufficient for 20 Masters level CATs.

Applicants who register for this Accredited Short Course as a Stand Alone student will pay the “Short course in health sciences” fee of £1890. This includes an option to submit the written assignment for academic credit. There is no reduction in the fee if this option is declined.

Possible essay topics
-Do evidence hierarchies have any useful purpose?
-Why is ‘pathophysiologic rationale’ not ranked highly in EBHC hierarchies?
-If ‘pathophysiologic rationale’ is undervalued as evidence for efficacy, can it play a role in generalizing the results of controlled studies, if so how?
-What is the role of clinical expertise in EBHC?
-What is the role of values in EBHC?
-If randomised trials provide ‘best’ evidence, why don’t we need them to show that stopping massive bleeding saves lives?
-Is CONSORT’s new policy on the importance of reporting the success of double blinding justified?
-Is it ethical to conduct systematic reviews of unethical studies?
-What are the historical roots of various aspects of EBHC methods?
-When did medical textbooks first start paying attention to ‘evidence’?
-How relevant is the year 1992 in the history of EBHC?

Level and demands
The main prerequisite for the course is enthusiasm for the subject. The course is designed to introduce students to the history and philosophy of EBHC and no background or education in history or philosophy will be required. Students will also generally be expected to have an undergraduate degree.

Recommended reading
The main texts associated with this course are:

Howick, J. (2011) The Philosophy of Evidence-Based Medicine: a philosophical inquiry. Blackwell-Wiley.
Chalmers I. James Lind Library: explaining and illustrating the evolution of fair tests of treatments. www.jameslindlibrary.org

Tröhler U (2000). ‘To improve the evidence of medicine’: the 18th century British origins of a critical approach. Edinburgh: Royal College of Physicians. Available for free download from http://tinyurl.com/9blkdjo.

Wootton, D. (2006) Bad Medicine. Oxford, Oxford University Press.

Fulford, KWM, Peile E., and Carrol, H. (forthcoming [2011] Essential Values-Based Medicine: linking science with people. Cambridge, CUP.

Teaching methods
The course will combine face-to-face teaching in Oxford and online distance learning. During the teaching week we will use a combination of short lectures, interactive seminars, group work and in-class activities. There will also be preparatory reading and online interaction before and after the course, with follow-up on extended essay preparation.

Teaching outcomes
By the end of the course students will
-be able to think more critically (decide what counts as an acceptable argument).
-successfully write an extended critical essay.
-be able to explain key ideas in philosophy, ‘epistemology’, ‘ontology’, ‘value theory’ the ‘rationalist/empiricist debate’, and ‘paradigm’.
-be able to defend and critique the EBM ‘hierarchy of evidence’ using philosophical principles’.
-be able to compare different historical approaches to the origins of EBHC (allocation, blinding, ‘placebo’ controls).
-be able to explain the role of values in EBHC.

Accommodation
Accommodation is available at the Rewley House Residential Centre, within the Department for Continuing Education, in central Oxford.

Scholarships
Application form for a Career Enhancement Scholarship PDF document.
A Career Enhancement Scholarship is available for this module for one Accredited Short Course applicant. This Scholarship will cover the full cost of tuition fees (£1,890) but excludes the cost of travel, accommodation and subsistence. The student is expected to cover these costs.

To apply please complete the “Application form for a Career Enhancement Scholarship” and return this with your Accredited Short Course Application. All applicants are asked to write a short paragraph (max 1000 words) about themselves. The Scholarship will be awarded to the applicant who shows greatest ability in terms of a) their existing experience to apply the new learning and b) their ability to influence and improve their local practice.

The deadline for applications for the EBHC Career Enhancement Scholarship for this module is 17:00 (GMT) on Friday 14 March 2014.

The successful applicant will be selected by the EBHC Standing Committee and will be notified of the outcome by Monday 14 April 2014. It is a requirement of the Scholarship that the successful applicant is willing to share their story. There will be an interview with each scholar after one year to identify how the course has supported their career enhancement.

Fee options
Programme Fee
Students enrolled on MSc in Evidence-Based Health Care: £1575.00
Short course in health sciences: £1890.00
Students enrolled on Postgraduate Dip in Health Research: £1575.00

Apply for this course
This course can be taken with academic credit (assignment of up to 4,000 words) or without academic credit, please indicate on your form which option you are applying for.

Admissions Criteria:
To apply for the course you should:
-be a graduate or have successfully completed a professional training course
-demonstrate an interest in the history or philosophy of evidence-based healthcare, either through graduate study or professional work
-identify a work or academic based problem for which you will be seeking evidence
-be able to combine intensive classroom learning with the application of the principles and practices of evidence-based health care within the work place
-have a good working knowledge of email, internet, word processing and Windows applications (for communications with course members, course team and administration)
-show evidence of the ability to commit time to study and an employer’s commitment to make time available to study, complete course work and attend course and university events and modules.

If you have any questions about your eligibility, please contact Jeremy Howick, module coordinator, directly on Jeremy.howick@phc.ox.ac.uk

You can apply for this course in the following ways:

Apply by post, email or fax
Application form PDF document found at http://www.conted.ox.ac.uk/courses/infosysfiles/_CPDStandAloneApp-Health.pdf.

Posted: April 03, 2014