Clever Nihilism: Cynicism in Evidence Based Medicine Learners

Abstract

Evidence-based medicine (EBM) educators are often confronted with learners who use their new critical appraisal skills to dismiss much of the medical literature. Does this cynical atti-tude of “clever nihilism” affect educational outcomes, such that educators need to tailor their cur-ricula to these learners? The authors proposed that this critical skepticism may be an intermediate developmental stage for EBM learners as they progress from “naïve empiricism” to “mature pragmatism”, and sought to observe its effect on educational outcomes from an intensive, 6 week EBM course. In this course, fifty-four medical residents reported significantly improved skills in critical appraisal and electronic searching. However there was no association between a measure of clever nihilism and the self-reported educational outcomes. The role of clever nihilism in the EBM classroom remains a potentially important issue, and its lack of effect here may be a product of several methodological limitations addressed in the discussion. Such a construct requires fur-ther validation The question remains as to whether such cynicism is a learning style or a devel-opmental phase.