Introduction to and techniques of evidence-based medicine.
METHODS
: Literature review.


OBJECTIVE
: To outline the components and application of evidence-based medicine (EBM) with an emphasis on the critical components of conduct and appraisal of clinical research.


BACKGROUND
: "Evidence-based medicine" is now a commonplace phrase representing the hallmark of excellence in clinical practice. EBM integrates a question, thoughtful comprehensive evaluation of the pertinent literature, with clinical experience and patient preference to make optimal patient care decisions. These decisions must be evaluated with objective outcome measures to ensure effectiveness. There have been some misconceptions around the application of EBM and that it is synonymous with randomized controlled trials (RCTs) or based purely on levels of evidence.


METHODS
: Narrative and review of literature.


CONCLUSIONS
: Clinicians must understand the importance of the research question, study design, and outcomes in order to apply the best available research to patient care. Treatment recommendations evolving from critical appraisal are not only based on levels of evidence, but the risk benefit ratio and cost. The true philosophy of EBM, however, is not for research to supplant individual clinical experience and the patient's informed preference, but to integrate them with the best available research. Healthcare professionals and administrators must grasp that EBM is not a RCT. They must realize that the question being asked and the research circumstances dictate the study design. Furthermore, they must not diminish the role of clinical expertise and informed patient preference in EBM.
Fisher
Charles G
CG
Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Charles.fisher@vch.ca
Wood
Kirkham B
KB
D019317:Evidence-Based Medicine / Q000379:methods* / Q000639:trends; D006801:Humans; D017060:Patient Satisfaction; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design / Q000639:trends*