Critical thinking, evidence-based medicine and clinical practice

Ideally physicians apply critical thinking skills to examination of current data bases in order to practice evidence based medicine. However many factors appear to work against this ideal. These factors have been examined as part of the development of a proposal for teaching critical thinking skills. The factors considered included CME programs and physician certification, pharmaceutical industry updates, physician training and experience, role models, incentives, and published reviews of health care practices. All of these factors were found to have strong elements inhibiting the use of personal critical thinking skills in the practice of evidence-based medicine. CME programs can enhance critical thinking skills if designed appropriately, bur rarely do. Pharmaceutical industry involvement must be viewed more critically. Physician training has not addressed the issue of critical thinking, allowing medical students little experience of using this skill. Faculty role models of critical thinking are rare. There are insufficient incentives to the use of critical thinking. Published reviews such as the Canadian Periodic Health Exam are counter productive to the use of critical thinking skills if used improperly. Diagnostic methods and therapy should be justified on the basis of scientific evidence and improved health care of the patient. Critical thinking skills essential to this process will be improved if attention is paid to the factors implicated as inhibitors.