Module 3: Fundamental Principles of Evidence-Based Medicine

Evidence-Based Medicine (EBM)

The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients

Objective of EBM

To integrate clinical expertise with the best available external clinical evidence from systematic research

Clinical Expertise

Involves the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice

Best Available Evidence

Evidence that comes from systematic summaries of research, including randomized controlled trials and meta-analyses

Trustworthiness of Evidence

Evaluating how confident we can be about the properties of diagnostic tests, patient prognoses, and therapeutic impacts

Systematic Research

Research that is conducted according to a specific plan or protocol to ensure rigor and minimize bias

Meta-Analysis

Combining data from multiple studies over time to increase the power and precision of the results

Importance of Evidence

Evidence is necessary but not sufficient; clinical experience and patient values also play a critical role in decision-making

Five Steps of EBM

Ask, Acquire, Appraise, Apply, Act

Ask

Formulate a structured clinical question

Acquire

Find the best relevant evidence

Appraise

Evaluate the evidence by assessing risk of bias, and understanding the results

Apply

Apply the results to patient care, considering patient-important outcomes and trade-offs

Act

Implement the evidence through shared decision-making with patients

Generalize Results

Apply the evidence to the individual patient considering their unique circumstances

Shared Decision-Making

Engage with the patient to make health decisions that incorporate their values and preferences

Three Fundamental Principles of EBM

Best Available Evidence, Trustworthiness of Evidence, Evidence is Necessary but not Sufficient

Best Available Evidence

Comes from systematic summaries and encompasses all relevant research

Trustworthiness of Evidence

Evaluating the quality and reliability of evidence, considering factors like bias and consistency

Evidence is Necessary but not Sufficient

Clinical experience and patient values are also critical in making health decisions

Systematic Summaries

Comprehensive reviews of all relevant studies on a specific topic

Evaluating Evidence

Assessing evidence for its quality, including aspects like risk of bias, precision, and applicability

Integrating Evidence and Experience

Combining research findings with clinical expertise and patient preferences for individualized care

Importance of Clinical Experience

Experience helps interpret evidence and apply it appropriately to individual patients

Cumulative Evidence

Evidence that builds over time through multiple studies, enhancing confidence in the results

Hierarchy of Evidence

A ranking system used to classify the strength of research according to its methodological quality and relevance

Lowest Level of Evidence

Unsystematic observations of individual clinicians

Basic Research

Second level of the hierarchy, includes laboratory and animal research

Observational Studies

Studies that measure the apparent impact on patient-important outcomes, one step above basic research

Randomized Controlled Trials (RCTs)

Second highest; providing high-quality evidence on treatment effectiveness

N-of-1 RCT

An individual trial where a patient and clinician are blind to whether the patient is receiving active or placebo medication

GRADE Framework

A system for grading the quality of evidence and strength of recommendations in healthcare

Quality of Evidence

High quality starts with RCTs; observational studies start as low quality but can be upgraded

Factors Affecting Confidence

Includes risk of bias, inconsistency, imprecision, and indirectness; large and consistent treatment effects can increase confidence