Evidence-Based Medicine

and Application
 What is EBM
• Evidence-based medicine (EBM) is the
integration of
- The best research evidence
- Clinical expertise
- Patient values
• conserns and expectations)
• Patient circumstances

Clinical Decision 
 Best research evidence
• valid and clinically relevant research
– from the basic sciences of medicine
– from patient-centered clinical research
• the accuracy of diagnostic tests (including
the clinical examination),
• the power of prognostic markers,
• and the efficacy and safety of therapeutic,
rehabilitative, and preventive regimens

The evidence can help us support the

patient care process
 Clinical expertise
• The ability to use our clinical skills and past
experience to rapidly identify:
– each patient’s unique health state and diagnosis,
– their individual risks and benefits of potential
interventions,
– their personal circumstances and expectations
 Patient values
– The unique preferences,
– concerns
– and expectations and circumstances ( clinical state
and setting)
each patient brings to a clinical encounter
and all of them must be integrated into
clinical decisions if they are to serve the
patient
 The results of the Integration of the three
elements

• Clinicians and patients form a diagnostic and

therapeutic alliance which optimizes clinical
outcomes and quality of life
• The practice of EBM is usually triggered
by patient encounters which generate
questions about the effects of therapy,
the utility of diagnostic tests, the
prognosis of diseases, or the etiology of
disorders
 The evidence
• does not make a decision
• it can help support the patient care process
• enhances the opportunity for optimal clinical
outcomes and quality of life
• generate questions about the effects of therapy, the
utility of diagnostic tests, the prognosis of diseases,
or the etiology of disorders
• requires new skills of the clinician, including efficient
literature-searching, and the application of formal
rules of evidence in evaluating the clinical literature.
 The Steps in the EBM Process
• Step 1. (The patient) Start with the patient -- a clinical
problem or question arises out of the care of the patient
.Converting the need for information (about prevention,
diagnosis, prognosis, therapy, causation, etc.) into an
answerable question.
• Step 2. (The question) Construct a well built clinical question
derived from the case Tracking down the best evidence with
which to answer that question
• Step 3 (The resource and Evaluation) Select the appropriate
resource(s) and conduct a searchCritically Appraising that
evidence for its validity (closeness to the truth), impact (size
of the effect), and applicability (usefulness in our clinical
practice)
 The Steps in the EBM Process (cont’d)
• Step 4 (Return to The patient) Integrating that
evidence with clinical expertise and with our
patient’s unique biology, values, and circumstances
patient preferences and apply it to practice
• Step 5 (Self-evaluation) Evaluating our effectiveness
and efficiency in executing steps 1-4 and seeking
ways to improve them both for next time and
evaluate our performance with this patient
The practice of evidence-based medicine

• process of lifelong
• self-directed
• problem-based learning
• need for clinically important information
about diagnosis, prognosis, therapy and other
clinical and health care issues
 WHAT ARE THE LIMITATIONS OF EBM?

• practice of EBM naturally engenders negative

and positive reactions from clinicians
• EBM is not an effective cost-cutting tool