10.2 Reading
C
Explain to students that this activity will help them to develop their skills at inferring information, that is, understanding information which is not directly stated. Sometimes the answer is in two parts of the text. In some cases, there may not be a clear answer.
10.2_C
Set for individual work and pairwork checking. Give students time to compare their answers, and then elicit and feed back visually with the class using the PDF. Together, underline parts of the text and feed back using the answers below.
Answers
1. Previous practice relied primarily on the experience of clinicians, while evidence-based medicine incorporates the best evidence available from the literature.
2. EBM aims to provide more positive treatment outcomes and more satisfi ed patients.
3. Both appear to be signifi cant problems, and there is no indication that one is greater than the other. However, students may have their own views, which they should justify based on what they have read.
4. Individual doctors don’t have time to identify and read all the available evidence for themselves.
5. Yes. Where clinical staff are encouraged to fi nd and evaluate evidence for themselves, the guidelines are more likely to be eff ective.
D
Remind students of the activity in Lesson 10.1, Exercise E, and ask them to review their answers.
Set for pairwork. Elicit from students that the phrases will give them an indication of how confi dent or tentative the writer is likely to be about the information which follows.
Ask students to fi rst fi nd and underline the phrases in the text and then to read what follows. T ey should then decide if the phrases are C – confi dent or T – tentative.
10.2_D
Elicit and visually feed back to the class, using the information in the table opposite and the PDF.
VOCABULARY BANK 10.4 Fixed phrases from academic English (3)
A list of these phrases can be found in Vocabulary Bank 10.4.
Answers It is generally agreed that …
Most practitioners seem to agree … … but the literature suggests …
Evidence from the literature indicates … It is clear that …
… but the consensus is that … Some writers have suggested … As a recent article indicates …
E
Set for pairwork and ask students to identify the marked words. Elicit the answers, and feed back verbally if necessary. Discuss any diff erences in students’ answers.
Ask students to fi nd more neutral alternatives. Ask whether it is hard to fi nd appropriate neutral words for some of the words and whether any of the existing words are appropriate. Elicit ideas, and feed back visually using the answers below.
Answers
Most practitioners seem to agree that implementing best practice is desirable, but the literature suggests that there can be signifi cant barriers to introducing evidence-based medicine in clinical settings. Evidence from the literature indicates that one of the most important of these barriers is the diffi culty of identifying the best treatment for the specifi c patient whom a doctor is treating. Clearly, patients are diff erent from each other in terms of age, gender, previous medical history and many other factors which have an impact on the eff ectiveness of a treatment. Unfortunately, as Greenhalgh et al.4
point out, many
authors have given little or no thought to how their studies ‘might be used, by whom, or for what’ (p.4). T is presents major diffi culties for doctors who are used to adapting treatments to the needs of specifi c patients.
Another problem is the very large number of publications. T e number of research articles has grown sharply over the past 20 years, and individual doctors don’t have time to identify and read all the available evidence for themselves. Yet to reach a decision on a particular treatment, it is essential to evaluate the strength of all the evidence.5
Systematic reviews, which
gather together and evaluate all the evidence on a clinical topic, can help overcome this problem. Evidence can take many diff erent forms, but the consensus is that only systematic reviews using randomized control trials can provide a ‘gold standard’ for the eff ectiveness of treatments. Producing these reviews to high standards can take a signifi cant amount of time, however. For example, the Cochrane Library, which is an outstanding source of high-quality reviews, has produced only around 8,000 topics. In addition, many of these topics relate to
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