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Evidence-Based Medicine (EBM)

Guide to EBM practices and resources


What is Evidence-Based Medicine?

Evidence-Based Medicine (EBM) as a subset of Evidence-Based Practice (EBP) is the "conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients" (Sackett, et al.). Using available evidence, or "grounds for belief" in the form of "facts or observations adduced in support of a conclusion" (OED), EBM takes into consideration available research in the biomedical sciences in conjunction with the clinical expertise of medical professionals alongside patient values and preferences.

Sackett, D. L., et al. (1996). Evidence based medicine: what it is and what it isn't. BMJ (Clinical research ed.)312(7023), 71–72. 

"evidence, n.". OED Online. December 2020. Oxford University Press.

Scope of EBM

EBM has come to be accepted as the most effective method of using available biomedical knowledge in the everyday practice of medicine. With rapid changes in medical knowledge and practice, understanding how to effectively integrate research and practice makes it easier to find, appraise, and apply evidence during busy clinical schedules. It further supports the ongoing research efforts of physicians and medical professionals whose career relies on continued scholarship.

Put in another way, "EBM requires clinicians to understand how uncertainty about clinical research evidence intersects with an individual patient's predicament and preferences" (Guyatt, et al.) This is further underscored in the three fundamental principles of EBM:

1) Awareness of the evidence on which one's practice is based.

2) Guidance and discernment to decide whether evidence is valid and reliable

3) Ability to further determine the risks, burden, and costs associated with standard or alternative management strategies alongside the consideration of patient values and preferences

Guyatt G, et al., Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed. McGraw Hill. JAMAevidence.

EBM 5 A's

Engaging with evidence toward its further application comprises 5 basic steps, often known as the 5 A's whereby clinicians must first

  • ASSESS a patient and their problem, asking a series of background and foreground questions prior to arriving at a formal query. This helps narrow the research framework for the clinical scenario while also taking into consideration any knowledge gaps that may exist. 
  • ASKing a formal question involves approaching the clinical scenario through a specific research framework (eg, PICO) that identifies the criteria needed and specifies the clinical category required. Posing a formal query also helps establish a set of terms needed to investigate the literature.
  • ACQUIR[E]ing the evidence involves selecting appropriate resources needed (databases, journals, point-of-care tools, practice guidelines, etc.), and then the right research which successfully addresses the query posed.
  • APPRAIS[E]ing the evidence gathered to ensure the validity and reliability of the information being used. This involves both an understanding of study design approaches to evaluation and the positioning of the information within various resources.
  • APPLYing the selected evidence involves integrating the research with clinical expertise and patient values to determine the proper course of action 
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