Evidence-based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. That is, it integrates the best external evidence with individual clinical expertise and patients' choice.
Evidence-based practice involves 5 steps:
1. Ask a focused question to satisfy the health needs of a specific patient
2. Find the best evidence by searching the literature
3. Critically appraise the literature: testing for validity, clinical relevance, and applicability
4. Apply the results in clinical practice
5. Evaluate the outcomes in your patient
Adapted from: the Centre for Evidence-Based Medicine and Sackett DL, Evidence based medicine: what it is and what it isn't. BMJ. 1996 Jan 13;312(7023):71-2.
There is a range in quality of evidence available in the literature, with systematic reviews being the very highest quality. As you move up the pyramid, the amount of literature decreases but its clinical relevance increases.
Sources of research may be either pre-appraised (summaries), primary literature or more anecdotal.
Systematic Reviews or Meta-analysis | PubMed, MEDLINE, SumSearch, Cochrane Library |
Critically-Appraised Topics | BMJ Clinical Evidence*, DynaMed*, UpToDate* |
Critically-Appraised Articles | ACP Journal Club (included in MEDLINE) |
Randomized Controlled Trials | Original articles |
Cohort Studies | Original articles |
Case-Controlled Studies etc. | Original articles |
Background Info/Expert Opinion | Books, editorials |
* Miami does not have a paid subscription.
What is the best kind of evidence to support your research question?
Type of Question / Domain | Type of Study / Methodology Methodologies defined |
Therapy / Treatment |
Randomized Controlled Trial (RCT) |
Diagnosis |
Controlled Trial |
Prognosis |
Cohort Studies |
Etiology / Harm | Cohort Studies |
Prevention |
Randomized Controlled Trial |
Quality of Life |
Qualitative Study |
Adapted from: Sackett et al.’s Evidence-Based Medicine: How to Practice and Teach EBM