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Center for Health Sciences
Medical Physiology - Evidence-Based Medicine
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Introduction

What is EBM?

Patient Care Model
Life-long Learning
Why is EBM Important?
Available Evidence?
EBM Issues

The Well-built Question

The EBM Process
Anatomy of a Question

Finding Evidence

Selecting a Resource
Searching the Resource
Reviewing Search Results
Returning to the Patient

Evaluating Evidence

Evaluating the Validity
Validity Questions

 

Knowledge Test

Multiple Sclerosis
Case #2
Case #3
Case #4

 

Reference/
Glossary
Feedback

Evidence-Based Medicine Issues


Opponents

Proponents

EBM is "old hat". Clinicians have been using the literature to guide their decisions for a long time. The label is new.

The new focus on EBM "formalizes" that "old hat" process and filters the literature so that decisions are made based on the best available evidence.

EBM is "cook book medicine". It suggests that decisions are based solely on the evidence, down playing sound clinical judgement.

Knowing the evidence is just one part of the process. Decisions must be based on a blend of individual clinical expertise, patient preferences and the best available evidence.

EBM is the mindless application of population studies to the treatment of the individual. It takes the results of studies of large groups of people and tries to apply them to individuals who may have unique circumstances or characteristics, not found in the study groups.

The last step in the EBM process is to decide whether or not the evidence from clinical trials and other studies is applicable to the care of your patient and to discuss the results with the patient.

Often there is no randomized controlled trial or "gold standard" in the literature to address the clinical question.

Clinicians might consider the "evidence pyramid" and look for the next best level of evidence. Clinicians need to understand that there may be no good evidence to support clinical judgement in a particular case.

There is often great difficulty in getting access to the evidence and in conducting effective searches to identify the best evidence.

Medical librarians can help identify the best resources and teach clinicians effective searching skills.

 

We now go to the next section, The Well-built Question: The EBM Process