1st EBVMA Podcast
Brennen McKenzie, MA, MS, VMD, cVMA:
Dr. McKenzie has always pursued a wide range of interests both within and outside of veterinary medicine. After completing a bachelor’s degree with majors in English Literature and Biology at the University of California at Santa Cruz, he followed the dream of becoming a primatologist. He obtained a Master’s in Physiology and Animal Behavior and worked for several years in environmental and behavioral enrichment for captive primates.
Switching gears, Dr. McKenzie then attended the School of Veterinary Medicine at the University of Pennsylvania and began working as a small animal general practice veterinarian. In the course of working to improve his knowledge and better educate his clients, he discovered evidence-based veterinary medicine, and he has served as Chair of the Practitioner Committee and President of the Evidence-Based Veterinary Medicine Association. Dr. McKenzie has also reached out to the public through his blog, the SkeptVet Blog, and his contributions to the Science-Based Medicine Blog and media interviews on veterinary medical topics.
While working as a practitioner, speaking, and writing, Dr. McKenzie has continued to pursue post-graduate training and completed his MSc in Epidemiology at the London School of Hygiene and Tropical Medicine in 2015. He hopes to continue both his clinical work and his efforts to promote wider implementation of evidence-based medicine in the veterinary profession.
In his sparse free time, Dr. McKenzie enjoys reading, hiking, playing his mandolin, travelling with his family, and sitting on the couch with his dogs watching the hummingbirds and woodpeckers outside his living room window.
Sharyn Esposito, DVM
Dr. Sharyn Esposito is a 1996 graduate of Colorado State University College of Veterinary Medicine and Biomedical Science. She received a Bachelor of Science in Animal Technology at the University of Denver before attending Veterinary School. Before graduation, she completed an externship at Kaytee Avian Research Center. She has been published in Popular Pets Magazine and currently serves on the board for Cavy Care Inc., a local guinea pig rescue.
During her 18 years of experience, Dr. Esposito has worked in several small animal hospitals and at present sees her clients at Smoky Hill Veterinary Clinic. Dr. Esposito is currently helping students at Bel-Rea Institute of Animal Technology master their clinical skills in their Preclinical Surgical Rotation. She nurtures a big family, including her Golden Retriever, three cats, a Blue and gold macaw, a Bearded dragon, Russian tortoise, three horses, and a flock of chickens with her husband and two children.
Erik Fausak, MSLIS, MA, CVT, LVT, RLAT
Erik has always had an interest in the role of animals and humanity since studying Anthropology at Beloit College, WI. In 1999, Erik attended Bel-Rea Institute of Animal Technology and worked at Alameda East Veterinary Hospital in Denver and Fifth Avenue Veterinary Specialists in New York City. His interest took him to graduate school at City University of New York, Hunter College, where his thesis work focused on langur phylogeny and neonatal coat color. Erik then attended library school at Pratt Institute.
Erik has been an active participant in the EBVMA and EBVM Network while teaching at Bel-Rea Institute of Animal Technology. Since then he has been an active proponent of incorporating evidence-based veterinary medicine in his curriculum and training his students to become research leads in evidence-based veterinary medicine. Currently his journal club has written two articles utilizing EBVM techniques.
Erik enjoys camping, hiking, biking, and boating with his wife, 3 year old son, and 2 dogs.
EBVM Introduction by Brennen McKenzie
Dr. McKenzie started the podcast by discussing Evidence-Based Veterinary Medicine (EBVM) and its role in the clinical environment. Key points as follows:
EBVM is the integration of scientific research into clinical practice in a more systematic and less haphazard way than in the past. It is important to understand that different evidence has different reliability.
EBVM allows for flexibility in practice. We aren't bound by what we were told to do, but can utilize recent science to inform new and better practices.
Sometimes finding the evidence can be challenging but allows us to know the limitations of our knowledge and acknowledging information gaps.
EBVM advantages in practice include:
Alleviation of practitioner bias that has always existed and is well documented by Clinical Psychology. It is a methodology and system for veterinarians to check themselves in practice.
Better patient care, staying current on the best interventions, which may sometimes mean no intervention.
Better ethics, being able to give the degree of certainty in patient care.
Client surveys conducted by Dr. McKenzie suggest that many clients are OK with clinician uncertainty but truth is paramount.
Key Points of Discussion
Discussion points included the following themes:
Communicating certainty to clients:
Dr. McKenzie pointed out that Science doesn't take the art out of medicine, but the art in medicine is client communication. Clients pay the veterinarian for the background work and expertise to find answers to their pet's problems.
Dr. Esposito stated that many veterinarians are interested in an honest exchange with their client and not necessarily trying to be a sales person, but at the end of the day, client wishes become a huge influence. Dr. Esposito mentioned that many clients now come out with multiple internet handouts that she helps them negotiate the information and reliability of these resources.
Present information to clients as you know it and dig deeper later. A clinician can start with the common questions and create their own resource. Utilizing that background research the clinician has done can later be shared with the veterinary community and the clinician becomes a producer of evidence.
Clients are OK with uncertainty, are veterinarians?
Dr. McKenzie emphasizes that EBVM is not about becoming robots and clinical decisions do not have to be based on a RCT, that is where clinical experience comes into play.
The culture is changing, and often more experienced clinicians can already accept their knowledge limitations, students are learning to utilize tools (like the RCVS Toolkit) to better inform theirs. Students are being trained to accept uncertainty.
Finally, What are limitations to the incorporation into EBVM?
Key limitations cited by many practitioners is time, two tools were mentioned in improving implementation:
Leveraging nursing staff, by training them in evidence finding
Utilizing and developing technology to make evidence easier to find. Much like what is being used in human medicine.
COCKCROFT, P. D., & HOLMES, M. A. (2003). Handbook of evidence-based veterinary medicine. Oxford, Blackwell Pub. - http://www.worldcat.org/title/handbook-of-evidence-based-veterinary-medicine/oclc/51481931&referer=brief_results
EBVMA – https://ebvma.org/
Dr. Brennen's blog - http://skeptvet.com/Blog/
Dr. Brennen's Science-Based Medicine Blogs - https://www.sciencebasedmedicine.org/contributors/brennen-mckenzie-ma-vmd/
Dr. Brennen's Introduction to Evidence Based Medicine in the Equine Veterinary Education Journal (open source) - http://onlinelibrary.wiley.com/doi/10.1111/eve.12216/full
Dr. Brennen's Article on EBVM in JAVMA - http://avmajournals.avma.org/doi/pdf/10.2460/javma.244.3.271
Dr. Brennen's Article on glucosamine in JAVMA - http://www.ncbi.nlm.nih.gov/pubmed/21155677
Centre for Evidence-based Veterinary Medicine - http://www.nottingham.ac.uk/CEVM/Index.aspx
Adobe Animal Hospital - http://www.adobe-animal.com/
Smokey Hill Veterinary Clinic - http://www.smokyhillvc.com/
Bel-Rea Institute of Animal Technology - http://belrea.edu/