Implication of evidence-based medicine in prescription guidelines taught to French medical students: Current status in the cardiovascular field

Objectives: To study how satisfactory the contents of introductory courses in cardiovascular therapeutics, given to medical students in France, are wi th respect to the concepts of evidence-based medicine. Methods: Medical school lecturers were asked to provide written course mate rial used as part of medical school courses, Best-available evidence was cl assified as existent (including two therapeutic subclasses: indicated and c ontraindicated), and nonexistent. Pour scores (from 0 to 10) were given, ac cording to conformity with best-available evidence, and citation of randomi zed clinical trials (RCT), meta-analyses and therapeutic objectives. Results: Thirty-four written documents were obtained from 43 faculties. Alt hough the score (mean +/- SEM) of conformity with best-available evidence w as 5.43 +/- 0.28 for the existent best-available evidence class, the corres ponding scores for the citation of RCT, meta-analyses, and therapeutic obje ctives were, respectively, 1 +/- 0.2, 0.16 +/- 0.07, and 2.7 +/- 0.3. The f our scores were highest when the best-available evidence belonged to the in dicated class, intermediate when best-available evidence was nonexistent, a nd lowest for the contraindicated class (P <.05), These scores were signifi cantly higher when the printed material was intended for specialists, Conclusion: Despite some limitations, the extent of agreement with the best -available evidence is only moderate. Pathophysiologic reasoning is largely preferred to justify the choice of therapeutics recommended to medical stu dents.