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Evidence-based medicine (EBM) is when providers integrate current research with their clinical expertise and patients’ values into medical decision-making.1 EBM has five basic components:

(1) developing a clinical question,
(2) finding the best available research addressing the clinical problem,
(3) critically appraising the evidence for validity, impact, and usefulness,
(4) applying the results in a clinical setting, and
(5) evaluating effectiveness.2

In 2001, the Institute of Medicine, an independent research group that provides national recommendations, cited the use of EBM as one of the top five most important factors for improving healthcare.3 Today however, despite growing support of EBM, there is still a gap between understanding and applying evidence-based recommendations to everyday healthcare.

Studies among medical professionals have found EBM attitudes favorable (i.e., thought to improve patient outcomes), but skills accessing and analyzing EBM are not standardized, and applications of clinical research findings are infrequent. An Australian study of nurses found that 96% of study participants agreed that EBM was fundamental to their profession, but 41% ranked themselves as beginners.4 A survey of Canadian chiropractors found that the majority practiced EBM less than five times a month.5 These same patterns have been found in systematic reviews across the globe; specifically, that inadequate knowledge, awareness, and confidence in EBM steps one through three affect implementation.6–8

While studies have found that the teaching style of EBM was not a factor, clinically integrated learning methods reflect the greatest improvement in skills, attitudes, and behaviors.9,10 This is good news for medical providers, because learning EBM skills on the job or teaching medical residents in a clinical setting is likely to be more effective than classroom learning. This learn-on-the-job technique has also been helpful in bringing EBM to new arenas such as disaster response. For example, during the 2015 Ebola outbreak in West Africa, technicians were encouraged to develop clinical questions and use available evidence when best-practice protocols were unavailable.11

EBM is the gold standard to ensure that best practices are used to provide medical care and improve outcomes, but the medical community continues to need strategies to increase uptake. There are still significant barriers in applying EBM to clinical practice that include time, workload limitations, and lack of training.4–7,12

At MDGuidelines, our product aids the implementation of EBM by providing convenient access to clinical decision-making tools.13 We develop evidence-based clinical guidelines that adhere to a rigorous and transparent methodology which supports medical providers by simplifying the EBM components.

To promote the use of EBM to improve patient outcomes, we are starting a program to offer free MDGuidelines access for medical residents to jump start their careers using evidence-based guidelines. Stay tuned for updates!

References

  1. Swanson JA, Schmitz D, Chung KC. How to Practice Evidence-Based Medicine. Plast Reconstr Surg. 2010;126(1):286-294.
  2. Straus S, Richardson WS, Glasziou P, Haynes B. Evidence-Based Medicine: How to Practice and Teach EBM. (Livingstone EC, ed.). Philadelphia; 2006.
  3. Institute of Medicine. Shaping the Future; Crossing the quality chasm: a new health system for the 21th century. IOM. 2001;(March):1-8.
  4. Malik G, McKenna L, Plummer V. Perceived Knowledge, Skills, Attitude and Contextual Factors Affecting Evidence-Based Practice Among Nurse Educators, Clinical Coaches and Nurse Specialists. Int J Nurs Pract. 2015;21(S2):46-57.
  5. Bussières AE, Terhorst L, Leach M, Stuber K, Evans R, Schneider MJ. Self-reported attitudes, skills and use of evidence-based practice among Canadian doctors of chiropractic: a national survey. J Can Chiropr Assoc. 2015;59(4):332-348.
  6. Upton D, Stephens D, Williams B, Scurlock-Evans L. Occupational therapists’ attitudes, knowledge, and implementation of evidence-based practice: A systematic review of published research. Br J Occup Ther. 2014;77(1):24-38.
  7. Scurlock-Evans L, Upton P, Upton D. Evidence-Based Practice in physiotherapy: a systematic review of barriers, enablers and interventions. Physiotherapy. 2014;100:208-219.
  8. Stronge M, Cahill M. Self-reported knowledge, attitudes and behaviour towards evidence-based practice of occupational therapy students in Ireland. Occup Ther Int. 2012;19(1):7-16.
  9. Ilic D, Nordin R Bin, Glasziou P, Tilson JK, Villanueva E. A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine Approaches to teaching and learning. BioMed Cent Med Educ. 2015;15(1):1-10.
  10. Coomarasamy A, Khan K. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. Br Med J. 2004;329(1):1-35.
  11. Peña-Fernández A, Choi EM-L. Novel Methods of Teaching Evidence-Based Medicine and Public Health: Experience From the Field During the Ebola Outbreak. In: ICERI2016 Proceedings. Seville; 2016.
  12. Mckenna K, Bennett S, Dierselhuis Z, Hoffmann T, Tooth L. Australian occupational therapists ’ use of an online evidence-based practice database (OTseeker). Health Info Libr J. 2005:205-214.
  13. ACOEM. Methodology for ACOEM’s Occupational Medicine Practice Guidelines – 2017 Revision. Salt Lake; 2017.

Kerri Wizner

Kerri Wizner

Kerri Wizner is the latest addition to the MDGuidelines team. She recently completed a Public Health Research Fellowship with the National Institute for Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control and Prevention (CDC). Her research and publications focus on utilizing surveillance to inform policies and practices to improve workplace safety in healthcare. Kerri has experience with academia, non-profit organizations, and state health departments supporting clinical trials and conducting surveillance. She has a Bachelor of Science degree from the University of Hawaii, Manoa in Microbiology and a Master of Public Health degree from Tulane University in Epidemiology. She is also Certified in Public Health by the National Board of Public Health Examiners.