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Evidence-Based Medicine

EBM is a systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values.
Sackett DL, Strauss SE, Richardson WS,et al. Evidence-based medicine: how to practice and teach EBM. London: Churchill-Livingstone, 2000

1. Ask a Clinical Question

The Clinical Question. Video from Yale Medical Library, 4 minutes. Background vs Foreground questions, types of clinical questions, types of research studies

Formulating Answerable Clinical Questions. Text from the Centre for Evidence-Based Medicine, Toronto. Uses a clinical scenario to illustrate construction of a PICO question, a framework for setting up a clinical question in such a way that searching for its answer becomes easier, and that results in answers relevant to patient care.

More Practise Formulating Clinical Questions. More scenarios from the Centre for Evidence-Based Medicine, Toronto. Construct your own clinical question for the scenario and compare it to their answer.

2. Acquire the Best Evidence

Haynes' 6S Approach to Finding High Quality Evidence Video with Terry Shaneyfeldt, MD MPH. 11 minutes.

EBM Tree Databases, Textbooks, and Websites for finding high quality evidence. From the Dana Medical Library

Use MeSH to Build a Better PubMed Query Video from the National Library of Medicine. 3 minutes. Extremely effective method for limiting a PubMed search to relevant references.

3. Appraise the Evidence

Users' Guides to the Medical Literature: I. How to Get StartedJAMA. 1993;270(17):2093-2095.

Users' Guides to the Medical Literature: II. How to Use an Article About Therapy or Prevention A. Are the Results of the Study Valid? JAMA. 1993;270(21):2598-2601.

Users' Guides to the Medical Literature: II. How to Use an Article About Therapy or Prevention B. What Were the Results and Will They Help Me in Caring for My Patients? JAMA. 1994;271(1):59-63

Users' Guides to the Medical Literature: III. How to Use an Article About a Diagnostic Test A. Are the Results of the Study Valid? JAMA. 1994;271(5):389-391.

Users' Guides to the Medical Literature: III. How to Use an Article About a Diagnostic Test B. What Are the Results and Will They Help Me in Caring for My Patients? JAMA. 1994;271(9):703-707.

Users' Guides to the Medical Literature: IV. How to Use an Article About Harm? JAMA. 1994;271(20):1615-1619.

Users' Guides to the Medical Literature: V. How to Use an Article about Prognosis? JAMA. 1994;272(3):234-237.

Users' Guides to the Medical Literature: VIII. How to Use Clinical Practice Guidelines A. Are the Recommendations Valid? JAMA. 1995;274(7):570-574.

Users' Guides to the Medical Literature: VIII. How to Use Clinical Practice Guidelines B. What Are the Recommendations and Will They Help You in Caring for Your Patients? JAMA. 1995;274(20):1630-1632.

Users' Guides to the Medical Literature: How to Read a Systematic Review and Meta-analysis and Apply the Results to Patient Care? JAMA. 2014;312(2):171-179.

4. Apply the Evidence

Apply the Evidence Worksheet Dartmouth College

5. Assess the Impact and Performance

From Nunan, David. Evidence-Based Medicine: What is it and why does it matter? Centre for Evidence-Based Medicine. Oxford. June 2016

  • How is your patient? – Short and long term, safety netting, follow up, handover
  • Did the decision improve the outcome of interest? – Log of activities, recall of patient encounters
  • What did I learn from that? – Reflection, significant event analysis
  • How might I use this experience again? – Building clinical expertise, personal development, write about it
  • How might I share this experience with others? – Dissemination of good (and bad) practice 

EBM Tools

Asking Focused Questions A table with tips for asking PICO questions, Centre for Evidence-Based Medicine, Oxford

Critical Appraisal Worksheets Dartmouth College

Stats Calculators: Odds Radio to NNT Converter; Diagnostic Tests, Prospective Studies, Case-Controlled Studies, RCTs. Centre for Evidence-Based Medicine, Toronto