Evidence-Based Medicine

 

Key Points:

  • Evidence-based medicine (EBM) is "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."
    • Sackett DL, Rosenberg WMC, Muir Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn't. BMJ. 1996;312:7172.
  • Effectively evaluating medical literature is an essential physician skill since the answer to many clinical questions are constantly evolving.
  • Successfully utilizing evidence medicine involves several steps:
    • Defining the question
    • Finding the evidence
    • Assessing the evidence
    • Applying the evidence
    • Effectively communicating the information 

 

Objectives:

  • Effectively assess the validity of medical literature including both therapy and diagnosis articles
  • Define and apply the following terms when assessing medical literature: sensitivity, specificity, likelihood ratios, pre-test probability

 

Recommended Resources: 

Brief Review

Watch

Evidence-Based Medicine in Practice #1. Professor Paul Glasziou. University of Oxford's Centre for Evidence-Based Medicine. 8 minutes.
https://youtu.be/DadRleW_pE4

Evidence-Based Medicine in Practice #2. Professor Paul Glasziou. University of Oxford's Centre for Evidence-Based Medicine. 5 minutes.
https://youtu.be/xLS1ng6D32Y?t=54s

Finding the evidence 1 - Using PICO to formulate a search question. Evidence-Based-Education. 2 minutes.
https://youtu.be/ypYkaKnn8_4?list=FLier2CaQeEuW1JOBn67ECjg

Finding the evidence 2 - Turning search terms into a search strategy. Evidence-Based-Education. 3 minutes.
https://www.youtube.com/watch?v=yho7_7zCOnA

Finding the evidence 3 - Turning your search strategy into results: PubMed demonstration. Evidence-Based-Education. 8 minutes.
https://youtu.be/kdff8AL5PGY

Evidence-Based Medicine in Practice - Diagnostic Tests #1. Dr. Carl Heneghan. University of Oxford's Centre for Evidence-Based Medicine. 7 minutes.
https://youtu.be/3B2dlz3aJ0Q?t=50s

Evidence-Based Medicine in Practice - Diagnostic Tests #2. Dr. Carl Heneghan. University of Oxford's Centre for Evidence-Based Medicine. 3 minutes.
https://youtu.be/tML0sQZw74A?t=50s

Read

Mojica M. The Making Evidence Based Medicine Simple Series. An evidence-based clinical practice curriculum consisting of 6 modules reviewing the articles types addressing the most common clinical questions (diagnosis, therapy, harm, prognosis, meta-analysis and clinical decision rule). Each module reviews an article from the medical literature using the Users Guide to Medical Literature criteria for validity, results and applicability. Each modules includes: a PowerPoint presentation with a script, a video of the presentation with narration, a quiz with answers, tips for teaching the module, a blank review form and a completed critical article review for the article reviewed in the module.

Diagnostic Testing Module. MedEdPORTAL Publications; 2013.
https://www.mededportal.org/publication/9475

Therapy Module. MedEdPORTAL Publications; 2013.
https://www.mededportal.org/publication/9478

Harm Module. MedEdPORTAL Publications; 2013.
https://www.mededportal.org/publication/9480

Prognosis Module. MedEdPORTAL Publications; 2013.
https://www.mededportal.org/publication/9440

Meta-analysis Module. MedEdPORTAL Publications; 2013.
https://www.mededportal.org/publication/9479

Clinical Decision Rule Module. MedEdPORTAL Publications; 2013.
https://www.mededportal.org/publication/9474

Do

Mayo Clinic Quality Academy Educational Resources. 12 free modules introducing quality improvement, patient safety, evidence-based medicine, and health policy. Certificates can be printed for each completed module.
http://qiresources.mayo.edu/

Weaver C. An Approach to Teaching Medical Students Evidence-Based Medicine and Basic Research Concepts. MedEdPORTAL Publications; 2006. The class provides online lecture presentations, research lectures, and tests to insure that the students gain an understanding of evidence-based medicine , basic clinical research principles, and research ethics.
https://www.mededportal.org/publication/415

 

In-Depth Review

Watch

Teaching Evidence-Based Medicine. University of Oxford's Centre for Evidence-Based Medicine. 5 video playlist.
https://www.youtube.com/playlist?list=PLPdZt8Yjl_fCRGGdV1jJCDMopI4jM2_UU

♥Practical Evidence-Based Medicine: An Introduction. Michael Glantz, MD. American Association of Neurological Surgeons. 44 minutes.
https://youtu.be/0xx4XcyAAo0

Evidence Based Medicine Series. Dr. Rahul Patwari. 6 videos.
http://www.aliem.com/category/clinical/patwari-videos/

Read

Frohna J. Fostering the Efficient, Effective Use of Evidence-Based Medicine in the Clinic. MedEdPORTAL Publications; 2006. A manual providing background, learning objectives, and teaching materials for faculty teaching evidence-based medicine with modules on asking questions, finding evidence, and appraising information.
https://www.mededportal.org/publication/151

Do

Understanding Evidence-based Healthcare: A Foundation for Action. Free online course. United States Cochrane Center. Johns Hopkins Bloomberg School of Public Health. 
http://us.cochrane.org/understanding-evidence-based-healthcare-foundation-action

Teaching Evidence-Based Medicine Workshop. 4 day course given annually. St Hughs College, Oxford, UK. Fee £1200.
http://www.cebm.net/education-and-training/teaching-evidence-based-medicine/

 

Resources for Evidence-Based Answers

Cochrane Library  *Free abstracts, fee required for full access
http://www.cochrane.org/

Trip Database
http://www.tripdatabase.com/

Database of Abstracts of Reviews of Effectiveness
http://www.crd.york.ac.uk/crdweb/

Clinical Evidence  *Fee required
www.clinicalevidence.com/

DynaMed  *Fee required
http://www.dynamicmedical.com/

Essential Evidence Plus  *Fee required
http://www.essentialevidenceplus.com/

Family Physicians Inquiries Network  *Fee required
http://www.fpin.org/

 

Biomedical Informatics Resources

Medical informatics curriculum. Florida State University.
http://med.fsu.edu/informatics

Hersh WR, Gorman PN, Biagioli FE, Mohan V, Gold JA, Mejicano GC. Beyond information retrieval and electronic health record use: competencies in clinical informatics for medical education. Adv Med Educ Pract. 2014 Jul 1;5:205-12. doi: 10.2147/AMEP.S63903. eCollection 2014. PubMed PMID: 25057246; PubMed Central PMCID: PMC4085140.
https://www.dovepress.com/beyond-information-retrieval-and-electronic-health-record-use-competen-peer-reviewed-fulltext-article-AMEP