Related EBM Tools

Asking Focused Questions


Finding the Evidence


Critical Appaisal


Making a Decision


Evaluating Performance

Understanding EBM in 4 days

Understanding EBM in 4 days Read Ami Banerjee's series of blogs: "Understanding Evidence-based Medicine in 4 days".
Read now

What is EBM?

Evidence-based medicine is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. Read the full article by clicking on the relevant link:

Evidence based medicine: what it is and what it isn't:
PubMed: 8555924
| PDF (0.5MB)

Good doctors and health professionals use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients. Evidence-based medicine is not restricted to randomised trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.

The Five Steps of EBP

Evidence-based practice is primarily based on five well defined steps. The five steps of EBP were first described in 1992 and most steps have now been subjected to trials of teaching effectiveness Sicily statement on evidence-based practice.

1. Asking Focused Questions: translation of uncertainty to an answerable question

What makes a clinical question well built? First, the question should be directly relevant to the problem at hand. Next, the question should be phrased to facilitate searching for a precise answer. To achieve these aims, the question must be focused and well articulated for all 4 parts of its 'anatomy'.

1.    the patient or problem being addressed;
2.    the intervention or exposure being considered;
3.    the comparison intervention or exposure, when relevant;
4.    the clinical outcomes of interest.

2. Finding the Evidence: systematic retrieval of best evidence available

Training improve search performance and the quality of evidence retrieved. Improving searching skills

Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment. Read more

3. Critical Appraisal: testing evidence for validity, clinical relevance, and applicability

Critical appraisal is the process of assessing and interpreting evidence by systematically considering its validity, results and relevance to an individual's work. Within the last decade critical appraisal has been added as a topic to many medical school and UK Royal College curricula, and several continuing professional development ventures have been funded to provide further training. Teaching critical appraisal skills in health care settings.

4. Making a Decision: application of results in practice

Many health professionals have recognized the need for instruction in evidence-based medicine. A curriculum intended to develop a resident-produced, evidence-based guideline for the care of patients with diabetes. Each resident was supervised going through the steps of evidence-based medicine: asking a clinical question, searching for the evidence to answer that question, appraising that evidence, and producing an evidence-based answer. These answers were then compiled into a guideline distributed in the residency practice. An evaluation of this curriculum using focus group and survey data showed that learners appreciated the skills and knowledge gained in devising guidelines in an evidence-based manner but were uncertain that their searches were complete. The clinical evaluation of the guideline implementation showed improvement in several clinical markers of diabetes care. Teaching evidence-based medicine skills through a residency-developed guideline.

5. Evaluating Performance: auditing evidence-based decisions

It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. One such strategy, audit and feedback, continues to be widely used as a strategy to improve professional practice.

 

What evidence is there that teaching EBM achieves its aims?

A five year old Cochrane review found sparse evidence"”one randomised controlled trial showing that about six hours of journal club time devoted to critical appraisal increased knowledge of this. Two subsequent randomised controlled trials with broader teaching showed a sustained educational benefit across several of  (Evidence based medicine has come a long way read more).

 

Incorporating EBM into practice

The likelihood that a clinician will incorporate EBM into their practice cannot be predicted by any demographics or practice related factors. Even those physicians who are enthusiastic about EBM rely more on traditional information sources than EBM related sources. The most important barriers to increased use of EBM by practicing physicians appears to be a lack of knowledge and familiarity with the basic skills, rather than skepticism about the concept. Read more

 

 

Page last edited: 01 November 2011