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Evidence Based Medicine

Information and resources about using EBM in patient care.

What is Evidence Based Medicine?

"The integration of individual clinical expertise with the best available clinical evidence from systematic research."
David L Sackett, W Scott Richardson, William Rosenberg, Brian Haynes, Evidence Based Medicine--How to Practice and Teach EBM, 2000.

The process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. Evidence-based medicine (EBM) follows four steps: formulate a clear clinical questions from a patient's problem; search the literature for relevant clinical articles; evaluate (critically appraise) the evidence for its validity and usefulness; implement useful findings in clinical practice. 
Rosenberg W, Donald A. Evidence based medicine: An approach to clinical problem-solving. BMJ. 1995;310:1122-1126

Proposed New Evidence-based Medicine Pyramid

"The proposed new evidence-based medicine pyramid. (A) The traditional pyramid. (B) Revising the pyramid: (1) lines separating the study designs become wavy (Grading of Recommendations Assessment, Development and Evaluation), (2) systematic reviews are 'chopped off' the pyramid. (C) The revised pyramid: systematic reviews are a lens through which evidence is viewed (applied)."
Murad MH, Asi N, Alsawas M, Alahdab F. New evidence pyramid. Evid Based Med. 2016 Aug;21(4):125-7. doi:10.1136/ebmed-2016-110401. Epub 2016 Jun 23. PMID: 27339128; PMCID: PMC4975798.

EBM method (5 steps)

Step 1: Assess your patient and determine the pertinent issues. You may be looking for evidence about therapy options, prognosis or diagnostic techniques.

Step 2: Ask a clinical question. Use the PICO model to formulate a clear and concise clinical question.

Step 3: Acquire the best evidence. Search the appropriate databases and resources to find the best evidence.

Step 4: Appraise the evidence. Determine whether the information you found is relevant, valid and applicable to your patient.

Step 5: Apply the evidence to your patient. Ensure that the evidence and recommendations meet your patient's values and expectations.  
The 5 Step EBM Method

Climbing the Pyramid of Evidence

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