Open Access Highly Accessed Open Badges Research article

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

Myriam M Altamirano-Bustamante12*, Nelly F Altamirano-Bustamante13, Alberto Lifshitz14, Ignacio Mora-Magaña3, Adalberto de Hoyos15, María Teresa Ávila-Osorio1, Silvia Quintana-Vargas6, Jorge A Aguirre6, Jorge Méndez1, Chiharu Murata3, Rodrigo Nava-Diosdado1, Oscar Martínez-González7, Elisa Calleja1, Raúl Vargas1, Juan Manuel Mejía-Arangure8, Araceli Cortez-Domínguez6, Fernand Vedrenne-Gutiérrez1, Perla Sueiras1, Juan Garduño9, Sergio Islas-Andrade2, Fabio Salamanca4, Jesús Kumate-Rodríguez10 and Alejandro Reyes-Fuentes10

Author Affiliations

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

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BMC Medicine 2013, 11:39  doi:10.1186/1741-7015-11-39

Published: 15 February 2013



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

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