An Introduction to Evidence-Based Practice for Medical Students

Just for fun:

• Isaacs D. Fitzgerald D. Seven alternatives to evidence based medicine. BMJ. 319(7225):1618, 1999 Dec 18-25.
• Clinicians for the Restoration of Autonomous Practice (CRAP) Writing Group. EBM: unmasking the ugly truth. BMJ. 325(7378):1496-8, 2002 Dec 21.
• Isaacs D. Issacs S. FItzgerald D. Evidence based merriment. BMJ. 339(7735):1449, 2009 Dec 19.

Evidence-Based Practice (EBP) is a 5 stage process:

1. Convert information needs into answerable questions.
2. Track down with maximum efficiency the best evidence with which to answer them.
3. Critically appraise that evidence for its validity and usefulness.
4. Apply the results of this appraisal to patient care.
5. Evaluate your performance.

• Introduction to Evidence-Based Medicine (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill)

Step 1: Convert information needs into answerable questions

• The Well-Built Clinical Question (Duke University Medical Center Library and Health Sciences Library, UNC-Chapel Hill)
• Formulating Patient Centered Questions
• Asking Focused Clinical Questions

Step 2: Track down with maximum efficiency the best evidence with which to answer them

Hierarchy of pre-processed evidence

[Adapted from DiCenso, Bayley and Haynes (2009). ACP Journal Club. Editorial: Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Annals of Internal Medicine, 151(6):JC3-2, JC3-3.]

Tips for Searching for the Evidence

Systems

“ “An evidence-based clinical information system integrates and concisely summarizes all relevant and important research evidence about a clinical problem, is updated as new research evidence becomes available, and automatically links (through an electronic medical record) a specific patient’s circumstances to the relevant information."

Summaries

"These include clinical pathways or textbook summaries that
integrate evidence-based information about specific clinical
problems and provide regular updating.

Syntheses: Systematic Reviews

"A synthesis or systematic review is a comprehensive summary of all the research evidence related to a focused clinical question. "

Synopses

“ “...a synopsis that summarizes the findings of a high-quality systematic review can often provide sufficient information to support clinical action... the synopsis of a single study provides a brief, but often sufficiently detailed, summary of a high-quality study that can inform clinical practice."

Of Syntheses:

• NHS Centre for Reviews and Dissemination (CRD) Databases, including:
  • Database of Abstracts of Reviews of Effects (DARE)
  • NHS Economic Evaluation Database (NHS EED)
  • Health Technology Assessment (HTA) Database
• health-evidence.ca "Promoting evidence-informed decision making"
• Evidence-Based Abstract Journals

Of Studies:

Studies:

Step 3: Critically appraise that evidence for its validity and usefulness

• Users' Guides to the Medical Literature (1st ed.) Click on Access UGI
• Critical Appraisal of Evidence (Centre for Evidence Based Practice, Toronto)
• How to Read a Paper: BMJ series by Trisha Greenhalgh on how to evaluate research articles.
  Including: Papers that report diagnostic or screening test
• Critical appraisal worksheets (Centre for Evidence Based Medicine, Toronto)
• Inclusion Criteria (McMaster Health Information Research Unit criteria for including articles in MacPLUS)

Other resources to help you understand concepts:

• Nicoll D. et al. Basic principles of diagnostic test use and interpretation. In: Pocket guide to diagnostic tests. 3rd ed.
• Perera R., Heneghan C. Making sense of diagnostic tests likelihood ratios. Evid Based Med 2006; 11: 130-131.
• STARD Statement (STAndards for the Reporting of Diagnostic accuracy studies)
• Survival Curves: The Basics (CancerGuide: Statistics)
• Glossaries and Health Care Statistics Terminology Resources
• Rational Clinical Exam series (JAMA)