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What began on the McMaster campus has developed into an international protocol for evidence-based medicine, an approach piloted by professor of clinical epidemiology and biostatistics Gordon Guyatt. Awarded a position in the Canadian Medical Hall of Fame for his work, Guyatt’s influence has spread throughout the western world.

“Throughout North America and Europe, bodies that accredit medical schools and training programs for physicians after they finish medical school have all adopted evidence-based medicine [into their curriculum],” said Guyatt, who sustains that evidence-based medicine bridges empirical data with clinical treatment.

“Evidence-based medicine has to do with being aware of the best available evidence… and being able to put that best evidence in the context of people’s values, preferences and circumstances relevant to choices that patients have to make,” he explained.

Currently more than 90 organizations worldwide abide by the policies and values of the Grading of Recommendations Assessment, Development and Evaluation, a system developed by Guyatt in what was a collaborative effort. GRADE became the epicenter of a cultural shift that has taken place over the last 20 years towards a formal clinical process in patient treatment. GRADE encourages physicians to adhere to guidelines that implement ideals that mesh well with evidence-based medicine. It has allowed for a system where evidence is appropriated before it can be applied.

Guyatt attributes the genesis of the evidence-based method to the community at McMaster.

“This could only have happened within a unique cultural environment that exists [at McMaster]. McMaster is known worldwide as the place where evidence-based medicine got started,” said Guyatt.

Guyatt was the director of Residency Program in Internal Medicine at McMaster in 1990. It was here that he first implemented the term evidence-based medicine. Caught up in the environment of the then new medical school at McMaster, and under the mentorship of clinical epidemiologist Dave Saket, he was inspired to explore an unconventional approach to health care.

“When McMaster Medical School started it was a revolutionary idea of a medical school. There were no tests, no examinations. Everything was based on problem-based learning. There was a great innovative spirit where challenging existing norms and values was highly valued,” Guyatt said.

The British Medical Journal ranked evidence-based learning as seventh among the most important changes in medicine in the last 50 years. Other developments on the list included computers, public health and anesthesiology.

Guyatt’s induction into the Canadian Medical Hall of fame is another notch in a long history of recognition.

“For me personally it’s nice, but more importantly than for me personally, it’s a recognition of the importance of the way that evidence-based medicine has impacted the medical practice.”

When asked about the future of evidence-based medicine, Guyatt likened it to the metaphor of turning an ocean liner around.

“It takes time,” Guyatt acknowledged. “It’s been 24 years since the term was coined, and we have been pushing and pushing and pushing. Eventually, if you’re in the right time, place and cultural environment, things will change. The ocean liner is just halfway turned around, now we just need to keep pushing until it turns all the way.”

Photo Credit: Jeff Comber

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