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      Promoting networks between evidence-based medicine and values-based medicine in continuing medical education

      , 1 , 2 , 1 , 3 , 1 , 4 , 3 , 1 , 5 , 1 , 6 , 6 , 1 , 3 , 1 , 7 , 1 , 1 , 8 , 6 , 1 , 1 , 9 , 2 , 4 , 10 , 10

      BMC Medicine

      BioMed Central

      clinical ethics, values, continuing medical education, concurrent triangulation strategy, axiology

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          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.


          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.


          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 10 th (order mean (OM) = 8.00) to the 3 rd 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.


          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.

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          Most cited references 31

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          Extending the Cross-Cultural Validity of the Theory of Basic Human Values with a Different Method of Measurement

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            Sex differences in value priorities: cross-cultural and multimethod studies.

            The authors assess sex differences in the importance of 10 basic values as guiding principles. Findings from 127 samples in 70 countries (N = 77,528) reveal that men attribute consistently more importance than women do to power, stimulation, hedonism, achievement, and self-direction values; the reverse is true for benevolence and universalism values and less consistently for security values. The sexes do not differ on tradition and conformity values. Sex differences are small (median d = .15; maximum d = .32 [power]) and typically explain less variance than age and much less than culture. Culture moderates all sex differences and sample type and measurement instrument have minor influences. The authors discuss compatibility of findings with evolutionary psychology and sex role theory and propose an agenda for future research. Copyright 2006 APA, all rights reserved.
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              Cross-national variation in the size of sex differences in values: effects of gender equality.

              How does gender equality relate to men's and women's value priorities? It is hypothesized that, for both sexes, the importance of benevolence, universalism, stimulation, hedonism, and self-direction values increases with greater gender equality, whereas the importance of power, achievement, security, and tradition values decreases. Of particular relevance to the present study, increased gender equality should also permit both sexes to pursue more freely the values they inherently care about more. Drawing on evolutionary and role theories, the authors postulate that women inherently value benevolence and universalism more than men do, whereas men inherently value power, achievement, and stimulation more than women do. Thus, as gender equality increases, sex differences in these values should increase, whereas sex differences in other values should not be affected by increases in gender equality. Studies of 25 representative national samples and of students from 68 countries confirmed the hypotheses except for tradition values. Implications for cross-cultural research on sex differences in values and traits are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

                Author and article information

                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central
                15 February 2013
                : 11
                : 39
                [1 ]Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico
                [2 ]Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico
                [3 ]Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Mexico 04530 D.F., Mexico
                [4 ]Unidad de Educación, Investigación y Políticas de Salud, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico
                [5 ]FES Acatlán, Universidad Nacional Autónoma de México, Av. San Juan Totoltepec, SN, Sta. Cruz Acatlán, 53150, Naucalpan de Juárez, Estado de Mexico, Mexico
                [6 ]Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro 36000, Guanajuato, Mexico
                [7 ]Universidad Anáhuac, México Norte, Av. Universidad Anáhuac 46, Lomas Anáhuac, Huixquilucan 52786, Estado de Mexico, Mexico
                [8 ]Unidad de Investigación en Epidemiología, Centro Médico Nacional Siglo XXI, IMSS, Av. Cuauhtémoc 330, Doctores, Mexico 06720 D.F., Mexico
                [9 ]Hospital Infantil de México "Federico Gómez", Secretaría de Salud, Dr. Márquez 162, Doctores, Mexico 06720, D.F., Mexico
                [10 ]Fundación IMSS, Paseo de la Reforma 476, Mexico 06600, D. F., Mexico
                Copyright ©2013 Altamirano-Bustamante et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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