title: Evidence-based medicine training in a resource-poor country, the importance of leveraging personal and institutional relationships.
abstract: OBJECTIVE
  Efforts to implement evidence-based medicine (EBM) training in developing countries are limited. We describe the results of an international effort to improve research capacity in a developing country; we conducted a course aimed at improving basic EBM attitudes and identified challenges.
  
  
  METHODS
  Between 2005 and 2009, we conducted an annual 3-day course in Perú consisting of interactive lectures and case-based workshops. We assessed self-reported competence and importance in EBM using a Likert scale (1 = low, 5 = high).
  
  
  RESULTS
  Totally 220 clinicians participated. For phase I (2005-2007), self-reported EBM competence increased from a median of 2 to 3 (P < 0.001) and the perceived importance of EBM did not change (median = 5). For phase II (2008-2009), before the course, 8-72% graded their competence very low (score of 1-2). After the course, 67-92% of subjects graded their increase in knowledge very high (score of 4-5). The challenges included limited availability of studies relevant to the local reality written in Spanish, participants' limited time and lack of long-term follow-up on practice change. Informal discussion and written evaluation from participants were universally in agreement that more training in EBM is needed.
  
  
  CONCLUSIONS
  In an EBM course in a resource-poor country, the baseline self-reported competence and experience on EBM were low, and the course had measurable improvements of self-reported competence, perceived utility and readiness to incorporate EBM into their practices. Similar to developed countries, translational research and building the research capacity in developing countries is critical for translating best available evidence into practice.
authors.affiliation: Universidad Peruana Cayetano Heredia, Lima, Perú.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tomatis
authors.forename: Claudia
authors.initials: C
authors.lastname: Taramona
authors.forename: Emiliana
authors.initials: E
authors.lastname: Rizo-Patrón
authors.forename: Fiorela
authors.initials: F
authors.lastname: Hernández
authors.forename: Patricia
authors.initials: P
authors.lastname: Rodríguez
authors.forename: Alejandro
authors.initials: A
authors.lastname: Piscoya
authors.forename: Elsa
authors.initials: E
authors.lastname: Gonzales
authors.forename: Eduardo
authors.initials: E
authors.lastname: Gotuzzo
authors.forename: Gustavo
authors.initials: G
authors.lastname: Heudebert
authors.forename: Robert M
authors.initials: RM
authors.lastname: Centor
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Estrada
mesh_terms: D002983:Clinical Competence / Q000592:standards; D003479:Curriculum; D004493:Education; D019317:Evidence-Based Medicine / Q000193:education*; D005163:Factor Analysis, Statistical; D006282:Health Personnel / Q000193:education*; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007391:International Cooperation; D010568:Peru; D011795:Surveys and Questionnaires