Evidence-Based Medicine: What is EBM?

EBM Defined

The most common definition of evidence-based medicine (EBM) is taken from Dr. David Sackett. EBM is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research." (Sackett D, 1996)

Read more at the UNC Introduction to Evidence-Based Medicine Tutorial.

Three Fundamental Principles of EBM

"Conceptually, EBM involves 3 fundamental principles. First, optimal clinical decision making requires awareness of the best available evidence...; Second, EBM provides guidance to confidence in clinical decision making with hierarchies of evidence; Third, evidence alone is never sufficient to make a clinical decision. Decision makers must always trade off the benefits and risks, burden, and costs associated with alternative management strategies and, in doing so, consider their patients' unique predicament and values and preferences." (Napodano, 1986)

Read the complete text of User's Guides to the medical literature: a manual for evidence-based clinical practice, a complete guide published by JAMA.

1. ASK - Start with the patient's individual case and convert your need for information (about prevention, diagnosis, prognosis, therapy, causation, etc.) into a focused clinical question. Use the PICO framework.

2. ACQUIRE - Search for the best evidence with which to answer that question.

3. APPRAISE - Critically evaluate the evidence for its validity (closeness to the truth), impact (size of the effect), and applicability (usefulness in clinical practice).

4. APPLY - Integrate the evidence with your clinical expertise and your patient's characteristics and values and apply it to practice.

5. ASSESS - Evaluate your performance with this patient and seek ways to improve in the future.

• EBM Glossary of Terms (Knowledge Translation Program, Toronto)
• EBM Glossary of Terms (American Family Physician)
• EBM Glossary of Terms (Evidence Based Medicine Toolkit, University of Alberta)