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Evidence Based Medicine (EBM)

This guide is designed to walk you through the Evidence Based Medicine process: the elements of a well-formulated clinical question, types of studies, and the key critical appraisal questions that help determine the validity of evidence.

Introduction to Evidence Based Medicine

What is evidence-based medicine?

Evidence-based medicine (EBM) is 'the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients' [1].

EBM integrates: 

  • The best available research evidence,
  • Clinical expertise, and
  • Patient preferences, values, concerns and expectations [2].

A different definition by Dawes et al. (2005) takes a more holistic approach to the broader topic of Evidence Based Practice:

(EBP) requires that decisions about health and social care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources [3].

1. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn'tBMJ. 1996; 312:71

2. Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: how to practice and teach it. 4th ed. Edinburgh: Churchill Livingstone Elsevier; 2011. 293 p.

3. Dawes M, Summerskill W, Glasziou P et al. Sicily statement on evidence-based practice. BMC Medical Education. 2005; 5:1

EBM provides a structured process for finding answers to clinical questions with maximum efficiency.

The established steps to EBM are:

  1. Ask a question
    Convert an information need into an answerable clinical question
  2. Access the research literature
    Use specialised EBM resources and/or reputable databases to find the best available research evidence to answer that question
  3. Appraise the research articles found
    Critically assess the validity and applicability of each study found
  4. Apply the research
    Integrate the research into practice. Combine it with patient values, circumstances and your own clinical expertise.
  5. Audit the outcomes
    Evaluate the effectiveness and efficiency of steps 1-4. What might you do differently next time?