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What is EBM?
Evidence based medicine (EBM) is the process of utilizing clinical expertise, research evidence and considering patient values, to come to a final clinical decision. This process of EBM de-emphasizes intuition and unsystematic clinical experience as sufficient grounds for clinical decision-making and stresses the examination of evidence from clinical research.
Steps of EBM
The practice of EBM consists of 5 steps:
- Ask: Constructing a relevant, answerable question derived from the case.
- Acquire: Selecting the appropriate databases or platforms in which to conduct a search, and then finding the most relevant evidence resources, such as journal articles, books, guidelines, or other information sources.
- Appraise: Appraising the evidence you’ve acquired for its validity and applicability.
- Apply: Applying the evidence to your practice.
- Assess: Reviewing the effect of the evidence-based decision you made upon your patient’s care, and continuing to apply the previous four steps to improve your overall EBM practice.
Constructing a Question
There are two types of questions:
- Background: Refers to questions that ask for general knowledge about a disorder, test, treatment, etc.
- Clinical Foreground: Refers to questions that are specific to a patient or problem. This type of question is what you will most commonly use to find evidence to apply in your practice. A well-constructed foreground question is formatted using the PICO structure.
Types of Clinical Foreground Questions
1. Guyatt G, Rennie D, Meade MO, Cook DJ, editors. User’s guide to the medical literature: a manual for evidence-based clinical practice [Internet]. 3rd ed. New York: McGraw-Hill; 2015 [cited 2017 Dec 12].
PICO stands for:
- Patient/Problem: Looking at things such as gender, age range, and medical condition
- Intervention: For example, form of therapy being proposed, type of diagnostic test, etc.
- Comparison: Is there a comparable test, therapy, or gold standard that can be compared to the proposed intervention? Keep in mind that in some cases a comparison element may not exist.
- Outcome: What is the overall outcome you wish to accomplish, measure, effect, etc.?
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