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MD 820: Searching for Evidence: Introduction to EBM

Library resources for searching, selecting, and evaluating evidence-based resources.

Step 1: Introduction to EBM

Evidence Based Medicine (EBM), or Evidence Based Practice (EBP), is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external evidence from systematic research."

Clinical information is often divided into two types of information: background information and foreground information. Background questions are needed when searching for general information on symptoms, disease progression, pathophysiology, or epidemiology. These questions generally require answering who, what, where, why and how. Background information is well accepted and consistent. Example: What are the symptoms of gastroparesis?

Foreground questions are needed when answering question regarding clinical care of a specific patient. Answering foreground questions require specific knowledge and often change with the addition of new research. With foreground questions, it helps to develop a focused question using PICO. Example: In adult patients with Allergic Rhinitis, are Intranasal steroids more effective than oral antihistamines in the management of symptoms?

Information comes in two forms:

  • Secondary literature analyzes, synopsizes, and synthesizes primary literature. The advantage of secondary literature is that the information has already been appraised by other professionals. These publications are at the top of the evidence pyramid, and therefore this information is among the highest quality information available.
  • Primary literature reports original research. This type of information is not pre-appraised, therefore you will be required to appraise the information for validity. One article describing causation is not always enough to effect decision making. If you are looking at individual articles consider appraising the Methods, Results, and Discussion. When reviewing primary literature, you should be able to find a description of the patients included and excluded, total number of patients studied, basic data so calculations can be completed, limitations, and interpretation of results.
Primary and Secondary Literature Pyramid

Finding Secondary Literature

For your MD 820 project you will need to look for Secondary Literature. You will learn more about searching for Secondary Literature under:

Granular Pyramid Single Studies vs. Summaries

Applying evidence to your case requires factoring in patient preferences, abilities, and resources as well as clinician experience and resources.

After applying the chosen therapy, it is important to perform assessment. Assessment involves evaluating your patient after the application of your evidence based decision. It also includes self-evaluation of your decision, process, and abilities. You must be a lifelong learner when applying evidence based practice principles.

EBM Venndiagram Adapted from Forrest,NCDHR ©2002