Epidemiology came about as the science responsible for studying epidemics of infectious diseases, giving it its name. Since the mid-20th century, the method used in Epidemiology began to be applied to the study of other diseases, such as cardiovascular diseases and cancer, which became significant public health problems in the most socioeconomically developed countries. Although the term we use is still the same, Epidemiology is currently responsible for studying the dynamics related to each health problem in human populations and, as a result, it should no longer be identified as a scientific discipline responsible solely for studying epidemics.
We can define Epidemiology as the science that, through a scientific working method, studies the frequency and distribution of diseases in human populations, their causes and the mechanisms that trigger them, as well as the biological and social factors that have an influence on them. This definition of Epidemiology refers to what we call General Epidemiology or Public Health Epidemiology, as it focuses on populations and its objectives are to promote health and prevent diseases among the population.
Clinical Epidemiology, on the other hand, seeks to improve the health of each patient; that is, it uses the methods of Epidemiology to achieve the best care practice possible. Because it uses a well-defined working method, Clinical Epidemiology is considered to be the backbone of clinical research through which knowledge is obtained that can be applied to improve clinical care. Therefore, in the 21st century, Epidemiology has become a key area of study for any medical specialization.
In the 1960s, movement began that criticized the variability and lack of scientific reason in the medical practice. A number of works were published that focused on the lack of critical summaries of the studies published and on the absence of scientific basis in clinical decisions, including those done by A. Cochrane, which would give rise to the first registry of clinical trials. (Cochrane AL (1972) Effectiveness and Efficiency: Random Reflections on Health Services. Nuffield Trust).
The concept of “evidence-based medicine” (EBM) was used for the first time in the early 1990s in an article published in the JAMA (Journal of the American Medical Association), one of the most prestigious and most widely read journals in the world. The term was created by a group of Clinical Epidemiology professors from the University of McMaster (Ontario, Canada) and was mistranslated into Spanish as medicina basada en la evidencia, as the term evidence means scientific test or observation and not evidencia in the sense of something obvious or irrefutable. EBM consists of the judicious integration of individual clinical experience with the best tests from scientific research, taking into account the values of each patient. The article published in the JAMA was titled Evidence-based medicine. A new approach to teaching the practice of medicine and it referred to the need for a new focus on teaching Medicine in which the students learned that clinical decisions must be based on the best scientific tests available. This requires appropriate training in Clinical Epidemiology, enabling doctors to select and analyze published research with a critical spirit, instilling in them the idea that they must always update their medical knowledge. From our point of view, the training received by students of the Bachelor’s Degree in Medicine should include content on statistics in the subjects included in Epidemiology, as statistics are a tool used in the epidemiological method to order and analyze what is observed and reach scientific conclusions that can be generalized (Rubio M, Hernando A, Mohedano R (2014). “Integrated learning of Epidemiology and Biostatistics: assessing students”. Journal of Educational Research. http://dx.doi.org/10.6018/rie.32.1.172601).
Meanwhile, Medical students need proper training to appropriately manage all the available bibliographic information. This requires knowledge and skills development to make efficient bibliographic searches and to select the medical studies with the highest scientific quality based on solid criteria. Once the bibliography has been selected, they must be able to understand the methods used for the study, to detect possible errors and limitations and to properly interpret the results. This training will be the basis for practicing EBM, regardless of their medical specialization in the future, and it must continue throughout their professional lives.
Adaptation to the European Higher Education Area was an opportunity to redesign learning strategies in university education. University education focuses not only an acquiring knowledge, but also on the development of competencies through teaching methodologies in which the student has active participation. In learning about Epidemiology, there is an example of the importance of having those methodologies, which can position the student before problems and situations that they will have to face as professionals and that will provide them with the tools to respond adequately (Rubio M, Sánchez-Ronco M, Mohedano R, Hernando A (2018) “The impact of participatory teaching methods on medical students’ perception of their abilities and knowledge of epidemiology and statistics”. PLoS ONE. https://doi.org/10.1371/journal.pone.0202769).
The practice of EBM has been criticized due to the excessively scientific approach of Medicine, which seems to ignore the humanist side. In response, the concept of patient-centered medicine has come about, which refers to considering each patient as a unique individual, taking into account their special characteristics, their perception of the disease, their values and preferences. In reality, they are not opposing concepts, rather a good doctor should be able to integrate the two approaches to achieve individualized and humanized clinical practice, but also based on the conclusions of the studies of the best scientific quality.