The EBM subcommittee of the OU-HCOM Curriculum
Advisory Committee (CAC) has adopted the definition of
evidence-based medicine (EBM) developed by David Sackett, M.D., and
colleagues (2000, p. 1):
"Evidence-based medicine (EBM) is the
integration of best research evidence with clinical
expertise and patient values…When these three elements
are integrated, clinicians and patients form a diagnostic and
therapeutic alliance which optimizes clinical outcomes and quality
of life."
"By best research evidence we mean
clinically relevant research, often from the basic sciences of
medicine, but especially from patient-centered clinical research
into the accuracy and precision of diagnostic tests (including the
clinical examination), the power of prognostic markers, and the
efficacy and safety of therapeutic, rehabilitative, and preventive
regimens. New evidence from clinical research both invalidates
previously accepted diagnostic tests and treatments and replaces
them with new ones that are more powerful, more accurate, more
efficacious, and safer."
"By clinical expertise we mean the
ability to use our clinical skills and past experience to rapidly
identify each patient's unique health state and diagnosis, their
individual risks and benefits of potential interventions, and their
personal values and expectations."
"By patient values we mean the unique
preferences, concerns and expectations each patient brings to a
clinical encounter and which must be integrated into clinical
decisions if they are to serve the patient."
Furthermore, the EBM subcommittee is developing
an outline of curricular learning objectives and activities
organized around the five steps of practicing EBM that were
articulated by Sackett and colleagues:
1. CONVERT the need for information into
answerable questions.
2. TRACK DOWN the best evidence with which to
answer the questions.
3. CRITICALLY APPRAISE the evidence for its
validity, impact, and applicability.
4. INTEGRATE the critical appraisal with our
clinical expertise and with our patient's unique
biology, values, and circumstances.
5. EVALUATE our effectiveness and efficiency in
executing steps 1-4 and seek ways to improve them both
for next time.
REFERENCE
Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., &
Haynes, R. B. (2000). Evidence-based medicine: How to practice
and teach EBM (2nd ed.). Edinburgh: Churchill Livingstone.
The book is available in the OU-HCOM LRC and the
OU Health Sciences Library. The book's website is the
Center for Evidence-Based
Medicine at the University of Toronto.
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