Evidence-Based Medicine (EBM)

Evidence-based medicine (EBM) is a fairly recent concept in the field of medicine, and it represents a major paradigm shift from the reliance exclusively on clinical expertise in healthcare decision making. EBM involves the integration of the best available research evidence with clinical [Page 386]experience and patient preferences. By combining these three components, the goal of EBM is to provide the best possible healthcare and obtain the best patient outcomes possible.

EBM involves five steps: (1) generating an answerable clinical question; (2) conducting a search to find the best research studies available that can answer the question; (3) critically evaluating the studies found for validity (closeness to the truth), impact (size of the effect), and applicability to clinical practice; (4) integrating the research evidence with the clinician's expertise and experience and the patient's values; and (5) evaluating the efficiency and effectiveness of conducting Steps 1 to 4 for potential improvements the next time they are implemented. Each of these steps is discussed in more detail below.

While it is believed that by applying findings from research studies as evidence to the application of clinical practices will result in improved decision making and patient outcomes, EBM has received mixed reactions by clinicians and academics. In real-world clinical practice, it is very difficult for clinicians to keep up-to-date with the rapid expansion of healthcare information being published. When faced with clinical questions concerning a diagnosis, prognosis, treatment, or general care, the answer is typically needed rapidly. With the volume of published information, most clinicians will only have time to read a small portion of what is available on a regular basis. The hope of EBM is that in the case of some of the more pertinent clinical questions, the evidence may have already been found, critically analyzed, and packaged in a format that is readily accessible to the busy clinician. Ultimately, the goal is to have patients, clinicians, healthcare managers, and policymakers have available to them healthcare research that is scientifically valid and readily applicable to clinical situations.