title: Promoting networks between evidence-based medicine and values-based medicine in continuing medical education.
abstract: BACKGROUND
  In recent years, medical practice has followed two different paradigms: evidence-based medicine (EBM) and values-based medicine (VBM). There is an urgent need to promote medical education that strengthens the relationship between these two paradigms. This work is designed to establish the foundations for a continuing medical education (CME) program aimed at encouraging the dialogue between EBM and VBM by determining the values relevant to everyday medical activities.
  
  
  METHODS
  A quasi-experimental, observational, comparative, prospective and qualitative study was conducted by analyzing through a concurrent triangulation strategy the correlation between healthcare personnel-patient relationship, healthcare personnel's life history, and ethical judgments regarding dilemmas that arise in daily clinical practice.In 2009, healthcare personnel working in Mexico were invited to participate in a free, online clinical ethics course. Each participant responded to a set of online survey instruments before and after the CME program. Face-to-face semi-structured interviews were conducted with healthcare personnel, focusing on their views and representations of clinical practice.
  
  
  RESULTS
  The healthcare personnel's core values were honesty and respect. There were significant differences in the clinical practice axiology before and after the course (P <0.001); notably, autonomy climbed from the 10th (order mean (OM) = 8.00) to the 3rd position (OM = 5.86). In ethical discernment, the CME program had an impact on autonomy (P ≤0.0001). Utilitarian autonomy was reinforced in the participants (P ≤0.0001). Regarding work values, significant differences due to the CME intervention were found in openness to change (OC) (P <0.000), self-transcendence (ST) (P <0.001), and self-enhancement (SE) (P <0.019). Predominant values in life history, ethical discernment and healthcare personnel-patient relation were beneficence, respect and compassion, respectively.
  
  
  CONCLUSIONS
  The healthcare personnel participating in a CME intervention in clinical ethics improved high-order values: Openness to change (OC) and Self Transcendence (ST), which are essential to fulfilling the healing ends of medicine. The CME intervention strengthened the role of educators and advisors with respect to healthcare personnel. The ethical values developed by healthcare professionals arise from their life history and their professional formation.
authors: Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Mexico 06720 D.F., Mexico. myriamab@unam.mx
authors: Myriam M
authors: MM
authors: Altamirano-Bustamante
authors: Nelly F
authors: NF
authors: Altamirano-Bustamante
authors: Alberto
authors: A
authors: Lifshitz
authors: Ignacio
authors: I
authors: Mora-Magaña
authors: Adalberto
authors: A
authors: de Hoyos
authors: María Teresa
authors: MT
authors: Avila-Osorio
authors: Silvia
authors: S
authors: Quintana-Vargas
authors: Jorge A
authors: JA
authors: Aguirre
authors: Jorge
authors: J
authors: Méndez
authors: Chiharu
authors: C
authors: Murata
authors: Rodrigo
authors: R
authors: Nava-Diosdado
authors: Oscar
authors: O
authors: Martínez-González
authors: Elisa
authors: E
authors: Calleja
authors: Raúl
authors: R
authors: Vargas
authors: Juan Manuel
authors: JM
authors: Mejía-Arangure
authors: Araceli
authors: A
authors: Cortez-Domínguez
authors: Fernand
authors: F
authors: Vedrenne-Gutiérrez
authors: Perla
authors: P
authors: Sueiras
authors: Juan
authors: J
authors: Garduño
authors: Sergio
authors: S
authors: Islas-Andrade
authors: Fabio
authors: F
authors: Salamanca
authors: Jesús
authors: J
authors: Kumate-Rodríguez
authors: Alejandro
authors: A
authors: Reyes-Fuentes
mesh_terms: D000328:Adult; D004502:Education, Medical, Continuing / Q000379:methods*; D019317:Evidence-Based Medicine / Q000941:ethics*; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008800:Mexico; D008875:Middle Aged; D011446:Prospective Studies; D062505:Value-Based Purchasing / Q000941:ethics*