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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

Framing Questions with PICO. Video from Yale Medical Library, 4 minutes. Construct a focused and answerable research question.

Asking Focused Questions Development of a PICO-format question, Centre for Evidence-Based Medicine, Oxford

2. Acquire the Best Evidence

EBM Tree Databases, Textbooks, and Websites for finding high quality evidence. Based on the Finding Information Framework. Cohen-Osher M, Davies TA, Flynn DB, Young ME, Hoffman M. Finding Information Framework: A Tool to Teach Life-Long Learning Skills. PRiMER. 2021;5:16.10.22454/PRiMER.2021.934572. Developed through a collaboration between UVM LCOM faculty and Dana Medical Library librarians.

Using PubMed in Evidence-Based Practice is a web-based tutorial that uses scenarios and exercises to enable users to accurately and precisely describe a clinical question using PICO and convert the research question into search terms for PubMed, resulting in efficient and thorough PubMed searches.This NIH tutorial takes about 30 minutes to complete.

Haynes' 6S Approach to Finding High Quality Evidence Video with Terry Shaneyfeldt, MD MPH. (11 min.) UAB

3. Appraise the Evidence

Guyatt G, Rennie D, Meade MO, Cook DJ. eds. Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed. McGraw Hill; 2015.

4. Apply the Evidence

Guyatt GH, Haynes RB, Jaeschke RZ, et al. Users' Guides to the Medical Literature: XXV. Evidence-Based Medicine: Principles for Applying the Users' Guides to Patient Care. JAMA. 2000;284(10):1290–1296. doi:10.1001/jama.284.10.1290

5. Assess the Impact and Performance

Self-Evaluation Approaches from the Knowledge Translation Program at St. Michael's Hospital, Toronto

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
  • How might I share this experience with others? – Dissemination of good (and bad) practice 

EBM Tools

Finding the Evidence: A How-to Guide Centre for Evidence-Based Medicine, University of Oxford

Critical Appraisal Worksheets Dartmouth College

Stats Calculators: Odds Radio to NNT Converter; Diagnostic Tests, Prospective Studies, Case-Controlled Studies, RCTs. from the Knowledge Translation Program at St. Michael's Hospital, Toronto