Evidence Based Medicine

Practicing Evidence
Based Medicine

Definition of
Evidence-Based Medicine
“Evidence based medicine is the conscientious, explicit,
and judicious use of current best evidence in makingdecisions 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 systematicresearch.”
–David Sackett, MD

Sackett DL et al. BMJ. 1996;312:71–72.

Steps in Practicing
Evidence-Based Medicine
Step 1:

Construct well-built and answerable clinical
questions

Step 2:Locate the best evidence to answer these
questions

Step 3:

Critically appraise your findings

Step 4:

Integrate findings with clinical expertise and
patient needs

Step 5:Evaluate your performance of these steps and
seek ways to improve

Sackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM . 2nd ed.
Churchill Livingstone; 2000.

Step 1: ConstructWell-Built Clinical
Questions
• “Background” questions
– Ask for general knowledge about a disorder

• “Foreground” questions
– Ask for specific knowledge about managing
patients with a disorderSackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed.
Churchill Livingstone; 2000.

Step 2: Locate the Best Evidence
• Sources of information and evidence mayinclude:

– Colleagues
– Textbooks
– Journals (e.g., evidence-based)

– Systematic reviews
– Guidelines

– Electronic databases
• Where to start searching may depend on:
– Available time

–Available databases
– Foreground versus background knowledge required
Sackett DL et al. Evidence-Based Medicine: How to Practice and Teach EBM. 2nd ed.
Churchill Livingstone; 2000.

SelectedElectronic Health Information
Resources
Resource

Internet Address

ACP Journal Club

www.acpjc.org

Cochrane Library

www.update-software.com

UpToDate

www.uptodate.com

PubMED...