Once again sitting in the back of the neuroscience and behavior class, and I've noticed another interesting phenomenon as the course as gone on. As we cover stroke, the clinical presenters are presenting much more clinical trial data than the other clinicians did (including myself for example as I the presentation on Parkinson's disease). Part of this is due to the veritable glut of evidence from strokologists. As stroke is very common, it is not hard to get large trials together, and the stroke literature is now quite robust. And, rightfully so, the stroke physicians are proud of their work, and want to communicate the data.
This raises a bit of a tension in the second-year neuroscience class. This tension is that these students were introduced to vascular anatomy yesterday, and stroke pathophysiology earlier in the morning. So how soon is too soon to talk about EBM? The focus of the course is more on learning the basic science, and getting an introduction to differetial diagnosis and treatment. Hence, when I talked about the clinical context of Parkinson's disease, I presented a lot about the clinical syndrome, and the differential diagnosis, and initial treatment options with pharmacologic information. As I'm a clinician, the pharmcology focused on adminstration route and side effects. But I didn't really show any primary literature in my slides. The stroke people showed a lot of primary literature - SPARKLE, CLOSURE, CREST, ECASS, NINDS tPA trial, the list of acronyms paraded across the screen.
So the tension lies in the fact that students do need to know that there is evidence which supports our clinical decisions. This evidence is often cited when I do ward attending rounds with the residents and the fourth-year students. But how much belongs in the first and second year coursework? When does it become overload when the student is still trying to grasp the basic concepts of pathophysiology? I'm not sure I have answers to these questions. As my lectures tend to show, I'm more for presenting basic data, and pivotal trial data in measured doses at this stage in training, and allow the learners to delve more deeply into EBM during the clinical years, and into their residency training. What do you think?