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(Stroke. 2004;35:392.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Evidence-Based Clinical Practice Education in Cerebrovascular Disease

Bart M. Demaerschalk, MD, MSc, FRCPC

From the Department of Neurology, Mayo Clinic College of Medicine, and the Divisions of Cerebrovascular Diseases and Critical Care Neurology, Department of Neurology, Mayo Clinic Scottsdale, 13400 East Shea Boulevard, Scottsdale, Ariz.

Correspondence and reprint requests to Bart M. Demaerschalk, Mayo Clinic Scottsdale, Stroke Centre, 13400 East Shea Blvd, Scottsdale, AZ 85259. E-mail demaerschalk.bart@mayo.edu

Key Words: Advances in Stroke • cerebrovascular disorders • education, medical • evidence-based medicine • teaching

An extract of the first 250 words of the full text is provided, because this article has no abstract.

An evidence-to-practice gap exists in stroke. Evidence-based clinical practice (EBCP) education may serve a role in overcoming this gap. EBCP training curricula belong in residency, fellowship, and continuing medical education programs. Examples of successful EBCP curricula already exist, replacing more traditional journal clubs. This brief review emphasizes how EBCP education can be integrated into stroke training and how it fits into the Accreditation Council for Graduate Medical Education core competencies.

Evidence to Practice Gap in Stroke

Although there has been an explosive growth in the design, conduct, and publication of clinical research in cerebrovascular disease, there continues to be an under- and inappropriate utilization of already existing and new evidence at the patient’s bedside. Numerous examples of this evidence-to-practice gap in stroke exist. Tissue plasminogen activator is estimated to be used in only 2% of all ischemic stroke patients in North America.¹ Fifty percent of American neurologists continue to use intravenous heparin for acute stroke in the face of evidence of nonefficacy and harm.² Fifteen percent of carotid endarterectomies are still performed for inappropriate indications.³ Adherence to evidence-based secondary stroke prevention strategies is generally low: 53% for antithrombotic therapy, 42% for hyperlipidemia treatment, 40% for use of warfarin in atrial fibrillation, 27% for hypertension control, and 18% for dedicated stroke units.⁴ Although the reasons behind the evidence-to-practice gap are multiple, variable, and complex, education in evidence-based cerebrovascular disease is a valuable tool in a global effort to bridge this gap and provide better overall care to stroke patients.

Evidence-Based Clinical Practice

The primary objective of education in evidence-based clinical . . . [Full Text of this Article]