Lecture critique d'article en médecine palliative : tentative de conciliation

The incentives for research and evaluation are increasing in palliative care. However, lack of methodological skills among professionals is an obstacle to their development. In 2009, a test for critical appraisal of literature (CAL) was introduced as a part of the national residency examination for medical students. Reading a scientific article is now recognized as one of the skills necessary to convey to future doctors. This paper first describes what CAL is and what it means to teach it. Second, it addresses the question whether or not CAL should be integrated as a part of a training program in palliative medicine and how this is feasible. CAL skills concern information retrieval and basic methodological knowledge necessary for the understanding of scientific information and analysis of its validity. Such skills are useful and necessary in palliative care as they are in all other medical or surgical specialties. However, CAL is based on a paradigm (evidence-based medicine), which has proved to be as powerful as potentially dangerous. Its underlying concepts must be used with caution and adapted to the constraints and founding principles of palliative care. This supposes strong motivation and open-minded collaboration between palliative care practitioners and methodologists.