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Evidence-Based Medicine Guide

A Library Guide to Evidence-Based Medicine

What is Evidence Based Medicine?

Evidence Based Medicine
An Overivew

There are many different definitions of evidence based medicine. One of the most comprehensive definitions was created by the Journal of the American Medical Association (JAMA) and adopted by the National Library of Medicine (NLM) for it's Medical Subject Headings (MeSH).

An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. [JAMA v.296(9), 2006]

The Fundamentals of EBM

There are three fundamental principles of EBM that should provide guidance in the practice of evidence based medicine.

  • Clinical Decision Making

    Working to find the optimal clinical decision for a patient's case based on awareness of best available evidence.

  • Evaluating Evidence vs. Experience

    Evaluating evidence levels and heirarchy to accurately assess and select the best theraputic option according to the evidence. While evidence is neccessary, it is not the only factor to evaluate; there may be times when a clinician's experience or a patient's values or preferences will carry more weight than the available evidence.

  • Risks and Benefits

    Considering the patient's unique case, values and perferences to evaluate the risks and benefits of the selected treatement, assess any additional burdens or costs that may be placed on the patient, and evaluate possible alternative treatments.

  • Adapted from Chapter 2: What is Evidence Based Medicine? Users' Guide to the Medical Literature, 3rd ed.

Practicing Evidence Based Medicine

Applying EBM in Clinical Practice

Evidence based medicine in clinical practice consists of four general steps: asking a question, collecting relevant information, evaluating the gathered evidence, and implementing the results in everyday clinical practice. However, quickly and accurately implementing these steps in a clinical setting can take some practice.

EBM Step by Step

  • Ask a Question
    1. Formulate a clear clinical / PICO question based upon the patient's case, symptoms, or diagnosis.
  • Collect Relevant Information
    1. Select and search the appropriate medical literature resources for relevant clinical articles, information, or data.
  • Evaluate the Evidence
    1. Critically evaluate/appraise the evidence from the selected articles for heirarchy, validity, and applicability.
    2. Based on the evaluation of the evidence, create a treatment plan or compile any useful clinical findings.
  • Implement the Results
    1. Make adjustments, or create alternatives, to the selected treatment plan or clinical findings based on the following considerations:
      • Risk vs. Benefit analysis
      • Patient's personal values and preferences
      • Personal clinical experience
    2. Implement the finalized treatment plan or clinical findings.