Using Clinical Evidence in a National Continuing Medical Education Program in Italy
Authors: Lorenzo Moja, Ivan Moschetti, Alessandro Liberati, Roberto Manfrini, Christian Deligant, Roberto Satolli, Antonio Addis, Nello Martini, Pietro Dri
Journal: PLoS Medicine (2007)

Interest in evidence-based medicine (EBM) is growing in Italy, although its impact upon health policies and clinical practice is unclear. Rather than getting health information from unbiased evidence-based sources, doctors in Italy still rely heavily upon the pharmaceutical industry for their information needs. For example, a recent survey showed that general practitioners receive 11 visits per week by pharmaceutical sales representatives [1]. The study suggested that this information is considered complete and sufficiently reliable by many doctors.

In an effort to ensure that all physicians have access to valid and reliable evidence on drug effectiveness and safety, the Italian Drug Agency (AIFA) launched a program to disseminate independent and unbiased information. The agency did this by translating Clinical Evidence, a compendium of the best available evidence on treating a wide range of common conditions (Box 1), into Italian and distributing it freely. By 2006, the fourth Italian edition (based on Clinical Evidence volume 14) had been published. The online Italian version of Clinical Evidence is freely available to all 248,000 doctors in practice in Italy.

Box 1. Clinical Evidence

Clinical Evidence (http://www.clinicalevidence.com) has specific features that make it different from both traditional textbooks and practice guidelines [19]: 


Its contents are driven by practical questions rather than by the availability of evidence.


It aims not to make recommendations but to inform based on the best available evidence.


It highlights rather than hides gaps in research evidence.


It is continuously updated.






According to its Web site, Clinical Evidence “describes the best available evidence from systematic reviews, RCTs [randomised controlled trials], and observational studies where appropriate, and if there is no good evidence it says so.”


In 1999, the first free distribution of 50,000 copies of Clinical Evidence was assessed through a survey exploring doctors' judgement of its validity, relevance, and usability. Results showed that the compendium had been well received, and confirmed doctors' preference for problem-driven information and the key role of a strong endorsement from health authorities for its implementation [2].

A compulsory system of continuing medical education (CME) for all health professionals was introduced in Italy in 1998, based on credits awarded for time spent on educational activities. The more traditional form of acquiring CME is to attend lectures and conferences; it is much more rare for doctors to be exposed to small group interactive events. In order to maximise the effectiveness of the financial commitment for disseminating Clinical Evidence, and to speed up the diffusion of EBM, AIFA sponsored a free-access e-learning system, based on Clinical Evidence, called ECCE (the Italian acronym for Continuing Education Clinical Evidence).