Evidence Based Medicine:

What is it?
Third-year Family Practice
Clerkship Orientation 2003-2004
Jennifer M Joyce, MD

Goals

Introduce evidence based medicine (EBM)

Discuss the different types of information

resources and information mastery skills

Introduce the EBM assignment

Definitions

Medicine:

The art and science of the diagnosis,

treatment, and prevention of disease and the
maintenance of good health.

Evidence

A thing or things helpful in forming a

conclusion or judgment.

Definitions 2

Evidenced-Based Medicine:

Evidence-Based Medicine (EBM) is

the integration of the best research
evidence with clinical expertise and
patient values.

Sackett

The Art of Integration

Clinical
Evidence

Research

Patient

Evidence

Preferences

Why EBM?

Daily need for information

Inadequacy of traditional sources of
information
Disparity between our diagnostic skills and
clinical judgment vs. up-to-date knowledge
and clinical performance
Develop skills for life long learning

Limitations of EBM

Lack of evidence
Funding sources limit the type and scope of
research projects
Access to information sources limited in clinical
setting
Inadequate research models to assess for the
complexity inherent in living systems.
Lack of skills to use available information
sources

INFORMATION MASTERY
Creating a culture of inquiry

Relevance x Validity
Usefulness of medical
=
information
work

Types of Information Databases

Primary sources

PubMed, MedLine
Require more work to validate

Secondary sources

Cochrane, Best Evidence, InfoPoems

Already reviewed- less work to validate
Limited amount of information studied

How good is the evidence?

Is it from a peer-reviewed journal?
(New England Journal of Medicine vs.
Practice)
Are the location and patients similar to mine?
Sponsored by an organization that may influence
the study design or results?

Will the information, if true, have an

impact on my patients and practice?

POEMs

vs.

DOEs

P- Patient

D- Disease

O- Oriented

O- Oriented

E Evidence

E- Evidence

that
M- Matters

POEMs
Example
Antiarrhythmic
Therapy

vs.

DOEs

DiseaseOriented
Evidence

Patient-Oriented
Evidence that
Matters

Drug X PVCs Drug X increases

on ECG
mortality

Comment
POEM study
contradicts DOE
study

Antihypertensive Antihypertensive Antihypertensive

POEM agrees
therapy
therapy BP
therapy mortality with DOE

Prostate
Screening

PSA screening
detects prostate
cancer early

? whether PSA
screening
mortality

DOE exists, but

the important
POEM is
unknown

Assignment

Compose a focused clinical question

Conduct a search for the evidence

Appraise the evidence for relevance

Appraise the validity of the information

Apply the information to patient care

Formulate a focused clinical

question

P- Patient

I- Intervention

C- Comparison

O- Outcome

Conduct a Search for the

Evidence

Search secondary (pre-appraised)

information sources
Cochrane
Best Evidence
National Guideline Clearinghouse

Search primary data sources

Appraise the evidence you find

Validity screening
-From a peer reviewed journal?
-Location and patients similar to mine?
-Sponsored by an organization that may
influence the study design?
-Will the information,if true, have an impact
on my patients and practice?

Appraise the evidence

Determine the intent of the article

-

Therapy
Diagnosis and screening
Causation
Prognosis
Education

Appraise the evidence

Fun with Numbers

Remember the important statistical values:

Relative Risk Reduction
Absolute Risk Reduction
Number Needed to Treat (NNT)
Sensitivity and Specificity
Positive and Negative Predictive Values
Likelihood Odds Ratios
Medical Center Library Webographies
Centre for Evidence Based Medicine

Apply the evidence

Short presentation at student conference

Consider a short presentation to your

preceptor

Continue using evidence to support your

common medical practices

Evaluate your performance

Self evaluation is key to successfully

practicing EBM

Am I asking answerable clinical questions?

Am I searching the literature?
Are you becoming more efficient in your
searches?
Are you integrating your critical appraisals
into your practice at all?

Summary

Evidence-based medicine is a systematic

approach to use up to date information in the
practice of medicine
Skills are needed to integrate the available
evidence with clinical experience and patient
concerns
Application and evaluation of EBM skills will
provide a frame work for life-long learning.