Evidence based medicine (EBM) was originally defined as the conscientious, explicit, and judicious use of current best evidence 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.
(Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-2)
The revised and improved definition of evidence-based medicine 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)
Evidence-Based Practice is defined as, "Making a conscientious effort to base clinical decisions on research that is most likely to be free from bias, and using interventions most likely to improve how long or well patients live."
(Mark H. Ebell, MD, MS, Professor, University of Georgia, Editor-in-Chief, Essential Evidence Plus)
While EBM is a large step forward, these skills are necessary but not sufficient for the practice of contemporary medicine. All clinicians should:
The practice of evidence-based medicine is a process of lifelong, self-directed, problem-based learning in which caring for one's own patients creates the need for clinically important information about diagnosis, prognosis, therapy and other clinical and health care issues.
Instead of routinely reviewing the contents of dozens of journals for interesting articles, EBM suggests that you target your reading to issues related to specific patient problems. Developing clinical questions and then searching current databases may be a more productive way of keeping current with the literature.
Evidence-based medicine "converts the abstract exercise of reading and appraising the literature into the pragmatic process of using the literature to benefit individual patients while simultaneously expanding the clinician's knowledge base."
(Bordley, D.R. Fagan M, Theige D. Evidence-based medicine: a powerful educational tool for clerkship education. Am J Med. 1997 May;102(5):427-32.)
To convert your information needs into a focused question, PICO format, see:
Ebell MH, Siwek J, Weiss BD, et al. Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician. 2004 Feb 1;69(3):548-56.
The EBM Pyramid hierarchy of rigor
A high-quality foraging tool employs a transparent process that
Highest level of rigor, systematically reviews the entire English publications on a topic. Full text available through Cochrane Library at Wiley. Cochrane Systematic Reviews on therapy topics only contain randomized clinical trials. (What is the Cochrane Collaboration?)
Journal published by FPIN, Family Physicians Inquiries Network, containing reviews of current research.
Patient Oriented Evidence that Matters. Published daily. Ongoing since 1996, editors review more than 1,200 studies monthly from 100+ medical journals, presenting only the best as InfoPOEMs. The acclaimed POEMs process applies specific criteria for validity and relevance to clinical practice. About 1 in 40 studies qualifies. (What is an InfoPOEM?)
US Preventative Services Task Force
An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.
Use online ePSS Tool or download PDA version here.
These resources combine many of the above resources into one tool that searches multiple resources, then organizes the results by category representing the type of question you have. Four of the following are available on the web and PDA for all CoM faculty and students. Step-by step-directions for using each of these products on the web and PDA is available in this PDF document: Using EBM Resources
Evidence-based evaluations of interventions for common clinical conditions developed in collaboration with the American College of Physicians, the American Society of Internal Medicine and BMJ. Available on PDA.
Essential Evidence Plus
Collection of systematic review, calculators, and other evidence based resources. Includes the Cochrane abstracts, InfoPOEM reviews, guidelines, clinical prediction tools, Essential Evidence and much more. Available on PDA.
DynaMed contains clinically organized summaries of nearly 1,800 topics and is updated daily from review of the research literature. Includes the Cochrane abstracts, ACP Journal Club, guidelines, USPSTF recommendations, their own reviews, as well as background materials. Available on PDA.
PIER (Physicians' Information and Education Resource) is a Web-based decision-support tool designed for rapid point-of-care delivery of up-to-date, evidence-based guidance for clinicians. The Maguire library has a subscription at the ACP. It is also free to all members of the ACP and to all medical students with an ACP membership at the same site.
One-stop-shop for clinical information presented in the context of clinical rotations for medical students. Includes the FPIN inquiries as well as comprehensive drug, disease, and lab references plus calculators and images. Available on PDA.
See EBM Tools on the Medical Library Website.
Last resort to track down evidence. Articles will need to be appraised before using.
MEDLINE at PubMed
Only a small percentage of clinicians in each specialty need to be able to do the following:
To help critically appraise an article or guideline, use the following guides:
Users' Guides to the Medical Literature
User guides to evidence-based practice from JAMA.
How to Read A Paper (series in BMJ) by Trisha Greenhalgh
Task Force Ratings From the Guide to Clinical Preventive Services, 2nd Ed.