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WHAT IS EVIDENCE BASED MEDICINE?

Evidence Based Medicine (EBM), Evidence Based Practice (EBP), and Evidence Based Medical Informatics (EBMI) all involve the understanding of how clinical knowledge and expertise, patient preference, and available evidence from research literature inform the decision-making of healthcare providers, (Guyatt, et al, 2015).

The application of Evidence-Based Medicine (EBM) includes using the best available research evidence, clinical expertise, and patient preference in order to inform clinical decision-making. In this guide, we will be focusing on Best Available Evidence and using library tools to search for this evidence. First, let's look at each component of EBM individually:

Best Available Evidence is the current body of research surrounding a case or question. Not all published literature is created equal, however. Asking the right question, acquiring the best results, and appraisal of the research are all important component of recognizing the best available evidence.

Clinical Expertise refers to a clinician's knowledge built over time. This also includes years of training and continuing education. Clinical knowledge and experience are necessary factors to consider when making a clinical decision. 

Patient Values and Preferences is the critical component of a patient's lifestyle, personal values, and other preferences and how this will impact the decisions they make regarding healthcare.

It is also important to note that each situation and case may be different and some situations may require judgement to determine what you need in a real life scenario. The reality might not look like three perfectly balanced circles with equal weight dedicated to each component, but the key idea to take away is that the practice of EBM occurs where the three concepts intersect as shown in the graphic below.

From the Users' guides to the medical literature: a manual for evidence-based clinical practice readings, best practices around evidence still requires skill in finding research studies that may be applicable to your clinical question. As a review:

HOW IS EVIDENCE BASED MEDICINE PRACTICED?

The practice of EBM requires utilization of the five A's:

ASK: Develop a focused, pertinent clinical question

ACQUIRE: Use information technology to access accurate and reliable medical information

APPRAISE: Evaluate the evidence using the appropriate criteria

APPLY: Apply findings to the question asked/to the patient's care

ACT: Communicate findings to the patient and/or team, reflecting on process and outcomes

from Guyatt, Gordon, and Maureen O. Meade.  (2015). "How to Use the Medical Literature—and This Book—to Improve Your Patient Care." Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed. McGraw Hill.

A final reminder about the application of the best available evidence is that the details of every case or situation will differ, but the skills used to be more confident in your appraisal and application of information start with asking the right question. When you use the principles of formulating a good clinical question with PICO (P=Population/Patient, I=Intervention, C= Comparison/Control, O=Outcomes), identifying relevant search terms, and understanding the basics of the tool or database you are using like what is included in the results and how the database processes your search terms, you will be more prepared to apply evidence when appropriate. 

As you review the 3 Fundamental Essentials of EBM from the Guyatt et al (2015) text, keep in mind that as you navigate the world of information, we are here to help. To schedule an appointment with a member of our team visit dartgo.org/hsl 

Want more EBM?

For a more comprehensive explanation of EBM, tips for developing searchable clinical questions with PICO, and review of other concepts covered in your courses, here is a recommended guide to consider:

Evidence Based Medicine Research Guide