- What is evidence-based medicine (EBM)?
- Myths about evidence-based medicine
- The need for evidence-based medicine
- Legal information
- Making this Site Work for You
- Step 1: Construct Clinical Question
- 2 Types of Questions
- Background Questions
- Foreground Questions
- PICO Format
- Primary vs. Secondary Sources
- Another Approach: Asking Well-Formed Clinical Questions
- Assessing Your Question
- Reasoning Behind Each Piece of Your Clinical Question
- Reevaluation and Reflection
- Step 2: Locate Evidence
- Evidence Pyramid (Quality of Evidence)
- Filtered Information
- Systematic Reviews/ Meta-Analyses
- Critically-Appraised Topics (Synthesis)
- Critically-Appraised Articles (Synopsis)
- Unfiltered Information
- Randomized Controlled Trials
- Cohort Studies
- Case-Controlled Studies/Case Series and Reports
- Background Info/Expert Opinion
- Search Basics & Using PubMed (Tutorial Alongside a Frame with PubMed)
(See Search Basics & Using PubMed for details.)
- Search Basics & Using PubMed
- Using the ATSU link-out to PubMed
- Brief lesson on general use of PubMed
- Using PubMed to find a systematic review
- More Advanced Searches & Using the Cochrane Library (Tutorial Alongside a Frame with the Cochrane Library)
(See More Advanced Searches & Using the Cochrane Library for details.)
- More Advanced Searches & Using the Cochrane Library
- Review of Prior Lessons: Evidence Pyramid
- Purpose of the Cochrane Library
- Access the Cochrane Library through the ATSU Portal
- Search the Cochrane Library
- Advanced Search
- MeSH Search
- Search History
- Saved Searches
- Step 3: Appraise Evidence
- Diagnosis Worksheet (pdf)
- How to Appraise an Article on Diagnosis (pdf)
- Statistics for Diagnosis
- Likelihood Ratios
- Pre-test Probabilities/Prevalence
- Post-Test Probabilities/Predictive Values
- Therapy Worksheet (pdf)
- How to Appraise an Article on Therapy (pdf)
- Systematic Review of Therapy (pdf)
- How to Appraise a Systematic Review (pdf)
- Statistics for Therapy
- Control Event Rate (CER)
- Experimental Event Rate (EER)
- Number Needed to Treat (NNT)
- Absolute Risk Reduction (ARR)
- Harm/Etiology Woorksheet (pdf)
- How to Appraise an Article on Harm (pdf)
- Statistics for Harm/Etiology
- Number Needed to Harm (NNH)
- Absolute Risk Increase (ARI)
- Relative Risk (RR)
- Odds Ratio (OR)
- Additional Statistical Tools and References
- Basic Statistics for Clinical Studies
- Samples and Populations
- Means and Medians
- Normal & Skewed Distributions
- Variability, Variance, & Standard Deviation
- Confidence Intervals
- Generalized 2x2 Clinical Table
- Clinical Statistics Calculator (Spreadsheet Application)
- Step 4: Integrate Evidence into Clinical Practice
- Unique Patients with Individual Medical Needs
- Are results applicable to my patient?
- The Art of Medicine
- Integrating Patient Preferences
- Step 5: Communication & Evaluation
- Communicate with Your Patients
- Communicate with Health Professionals
- Evaluate Yourself
- How did you do?
- Basic Computer Skills
- Appraisal Worksheets
(Also see Step 3.)
- PowerPoint Downloads
- More Information
What is evidence-based medicine (EBM)?
Evidence-based medicine is defined as “the conscientious, explicit and judicious use of current best medicine in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” by David L. Sackett and his colleagues.
It has been simplified over time to be “the integration of best research evidence with clinical expertise and patient values”.
Myths about evidence-based medicine
Evidence-based medicine is not a new concept. The term evidence-based medicine was coined in 1992 by a group at McMaster University, but clinicians have always used evidence to make decisions about patient care. The evidence just may not have been the “best” evidence due to any number of reasons.
Some fear that EBM is an example of cookbook medicine, a way to cut costs of health care, or a way to keep patients from receiving the care they deserve. None of these fears is true. There will never be one recipe that fits all patients, and as stated clearly in the definitions above, EBM involves integration of clinical expertise and individual patient values. In some cases, the results of EBM may cut costs by eliminating unnecessary procedures or treatments; however there also may be situations where it is the expensive procedure or treatment that provides the best results for patients. Along that same line, practicing EBM is a way to eliminate unnecessary expenditure which in theory would allow more money to decrease the treatment and diagnostic disparities that are present in today’s society.
Many can agree with the concept of EBM but are unsure that it can be practiced in a busy clinic. In reality, it is those busy clinicians who can benefit the most from the growth of EBM. As the search engines become quicker and the number of secondary sources grows, it will be easier than ever to find the answer to a clinical question that arises from a fifteen minute office visit.
The need for evidence-based medicine
Studies suggest our need for best evidence occurs twice in every three outpatient visits and up to five times per inpatient visit. The amount of new medical information formed daily is overwhelming. It is impossible to know everything. With this rapid formation of data, familiar sources such as textbooks are out of date by the time they reach the shelf. The development of online EBM tools and journals containing pre-analyzed articles help individual providers keep current.
Most importantly, practicing evidence-based medicine leads to improved patient outcomes.
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This website is made possible by the Academic Administrative Units in Primary Care grant D54HP05442 between A.T. Still University-Kirksville College of Osteopathic Medicine and the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Medicine. Margaret A. Wilson, D.O., is the project director.
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