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    Evidence Based Medicine*
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Introduction to EBM

The purpose of this web site is to familiarize its visitors with the principles, practice, and process of evidence based medicine. The information and the links provided here are intended for medical students, residents, faculty, practicing health professionals, and anyone who has an interest in this emerging method of problem solving. The four major sections included will be helpful to a wide audience of individuals who have a brief to expert knowledge of this topic

This guide prepared by Gerstein Science Information Centre Staff: Patricia Yu in 2000; revised by Esther Atkinson 2004. Comments or questions should be sent to ask.gerstein@utoronto.ca

What is Evidence Based Medicine (EBM)?
Evidence based medicine is 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.

from Sackett, DL, et al. "Evidence based medicine: What it is and what it isn't." (BMJ 1996; 312: 71-2)

Why EBM?
  • Practicing evidence based medicine allows clinicians to keep up with the rapidly growing body of medical literature
  • Evidence based medicine improves clinicians' skills in asking answerable questions and finding the best evidence to answer these questions
  • Evidence based medicine can provide a framework for critically appraising evidence
  • Practicing evidence based medicine encourages clinicians to integrate valid and useful evidence with clinical expertise and each patient's unique features, and enables clinicians to apply evidence to the treatment of patients

adapted from Straus, SE and Sackett, DL. "Getting research findings into practice: Using research findings in clinical practice." (BMJ 1998; 317: 339-42)

The Steps in Practicing EBM

A general overview:

1. formulate a clear, focused clinical question based on a patient's specific problem
2. consider four components of a well built clinical question; the PICO model

  • P patients or population
  • I intervention
  • C comparison group(s)
  • O outcomes of interest

3. search the literature for the best external evidence
4. critically appraise the evidence for its validity and usefulness
5. implement the useful evidence in clinical practice
6. evaluate your performance as a practitioner of EBM

Learning how to perform each of these steps with expertise is a prerequisite to practicing EBM that results in the best possible care for patients. The following pages serve as a guide to resources that can provide a greater understanding of the steps in the EBM process. There are a number of excellent online tutorials available that breakdown the process involved, and provide step-by-step guidance for practitioners. Check under Tutorials in the Tools for EBM section.

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