Evidence-Based Medicine

Origins

The term evidence-based medicine was coined in 1990 by Gordon Guyatt. While there have been many contributors to the development of EBM, Guyatt and his colleagues at McMaster University— principal among them David Sackett and Brian Haynes—have played major roles in developing the principles of EBM and have been instrumental in popularizing it throughout the world. In 1985, Sackett, Haynes, and Guyatt, together with Peter Tugwell, published the book Clinical Epidemiology: A Basic Science for Clinical Medicine. In this book, the authors explained, simplified, and organized the basic EBM principles (though not yet referred to as EBM) for the practicing clinician. In essence, this was the first EBM book, which served as the basis for their later books and articles that generated and developed the EBM approach to clinical practice.

Scope

EBM was developed for practicing physicians. However, over the past decade, it became increasingly clear that many other professions participating in patient care would benefit equally from the EBM approach. In recent years, dentistry, nursing, pharmacy, physical therapy, occupational therapy, public health, library sciences, and other disciplines have developed a strong interest in EBM. With this broadened focus, the term EBM is slowly being replaced with EBP, evidence-based practice.

The past decade also has seen the rapid spread of EBM learning in all aspects of medical training. It is routine now in medical schools and residency programs in North America, Europe, and elsewhere to include EBM as a standard part of their curriculum. The acquisition of skills of critical judgment is a requirement of the Liaison Committee on Medical Education (accreditation committee for medical schools) in the United States. EBM learning is explicitly mentioned in the standards of the Accreditation Council for Graduate Medical Education and is included among the subcategories of their six core competencies for residency programs in the United States.

One remarkable corollary of EBM's increasing popularity has been the encouragement and expectation of scientific rigor in clinical research. This has led to the ubiquitous use of statistical methods to evaluate results, the rise of the randomized controlled trial as the standard for determining therapeutic benefit, and greater attention generally to methodological validity across all areas of clinical investigation.

Finally, the emergence of EBM has brought about a changed relationship of the practicing clinician to the medical literature. Previously, the busy clinician was forever attempting to catch up on journal reading—most poignantly represented by unread stacks of journals lying forlorn in the corner of one's office. The EBM process has encouraged decreasing catch-up journal reading and increasing patient-focused journal reading. The patient encounter has become the catalyst of learning about new treatments, diagnostic tests, [Page 468]and prognostic indicators and the focus of a personal program of continuing medical education.

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