This guide contains an introduction to evidence-based practice for students and clinicians. The tutorial will walk you through the steps of the evidence-based practice process and allow you to practice at each stage.
Pioneer of evidence-based medicine, David Sackett, described EBM as, "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating clinical expertise with the best available external clinical evidence from systematic research." Evidence shouldn't be the only factor in your decision-making, but it will support the patient care process - it's a tool that should be used alongside your medical knowledge and your patient's values and expectations.
Following the steps in the evidence-based practice process will allow you to separate the best clinically relevant and patient-oriented evidence from everything else. Being able to do this is important because conventional wisdom is not always accurate. Below are two examples that demonstrate this.
Hormone Replacement Therapy
Pre-menopausal women were observed to have less heart disease than men of the same age, but menopausal women and men of the same age were observed to have the same rate of heart disease. Because of this, the assumption was made that estrogen must be cardioprotective and hormone replacement therapy should be prescribed for menopausal women. However, the Women’s Health Initiative study (2002) actually showed an increase in heart attacks, stroke, and breast cancer in women on hormone replacement therapy. The risks of the treatment outweighed the treatment, so the trial had to be stopped early.
“Back to Sleep” Campaign
Until the last couple of decades, it was common practice to recommend that parents ensure that their babies slept on their stomachs to prevent sudden infant death syndrome (SIDS). It wasn’t until the eighties that physicians began to question the legitimacy of this practice. By looking at the available evidence, these physicians actually found that SIDS actually was decreased by ensuring that babies were sleeping on their backs. With this information, the Back to Sleep campaign was launched in 1994. Since the initiation of this campaign, the rate of SIDS cases has been cut in half.
Knowing how to search for and evaluate the medical literature will help you make better clinical decisions and can save lives. More immediately for you, you’re going to need to search the literature during your clerkships. You might present at morning report or journal club or need to provide information to your chief resident.
It is important to keep in mind that what you are learning in medical school is going to become outdated, and it is impossible to keep up with the rate of new publications in medicine. Even if you were to read all day, every day, you would not be able to get through it all. In addition to this, current practices vary and there is always more than one expert opinion. As such, you will need to find a way to review the material systematically.
This guide contains excerpts and examples from: