By best available research, we mean clinically relevant (i.e. patient oriented) research that: Evidence-based medicine (EBMa) refers to the application of the best available research to clinical care, which requires the integration of evidence with clinical expertise and patient values.[1,2]

  • Illuminates the accuracy and precision of diagnostic tests,
  • Highlights the importance of prognostic markers,
  • Establishes the efficacy and safety of therapeutic, rehabilitative, or preventive healthcare strategies, or
  • Seeks to understand the patient experience.

Physicians must use their clinical skills and prior experience to rapidly identify each patient’s unique clinical situation, applying the evidence tailored to the individual’s risks versus benefits of potential interventions. Ultimately, the normative goal of EBM is to support the patient by contextualizing the evidence with their preferences, concerns and expectations. This results in a process of shared decision-making, in which the patient’s values, circumstances, and setting dictate the best care.

The widespread use of EBM in many healthcare disciplines reflects its broad impact. EBM is also an important tool for social justice. If applied appropriately, it has the potential to be a great equalizer – striving for equitable care for patients in disparate parts of the world. Furthermore, EBM plays a prominent role in policy-making; politicians are increasingly speaking to their use of research evidence to inform their decision-making as a declaration of legitimacy. [3, 4]

Its history has been artfully described in ‘an oral history of EBM’, presented by Dr. Richard Smith, which includes discussions with the founders of EBM – including Drs David Sackett, Brian Haynes, and Gordon Guyatt.[5] Interested readers can also reference the James Lind Library, which outlines many seminal moments in EBM history.[6]  The bottom line of these articles is that EBM is not a new concept but rather it reflects the work of countless people who have improved the process of generating clinical evidence over several decades, and that it continues to evolve.

Developing the skills to practice EBM requires access to evidence, opportunities to practice, and time. We hope this portal will be a starting point. You might choose to use this resource to become a more savvy consumer of the literature or to become the next person to advance this collective wisdom. Much work remains: finding novel ways to integrate evidence into personal health records for use at the bedside and in the patient’s home, improving strategies for risk communication, and finding ways to learn and practice medicine in the face of uncertainty [7] are ripe for efforts. We hope you’ll join this ongoing conversation.

Reena Pattani MD MPH FRCPC
Assistant Professor,
Division of General Internal Medicine
Department of Medicine
St. Michael’s Hospital
University of Toronto

Sharon E. Straus MD MSc FRCPC
Professor,
Division of Geriatric Medicine
Department of Medicine
St. Michael’s Hospital
University of Toronto

Acknowledgements: SES is funded by a Tier 1 Canada Research Chair.

The term EBM is used interchangeably with evidence-based practice or evidence-based health care.
Occupational therapy, physiotherapy, nursing, dentistry, and complementary medicine, to name a few.

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References

  1. Evidence-based Medicine Working Group. Evidence-based medicine.  A new approach to teaching the practice of medicine. JAMA 1992;268:2420-5.
  2. Straus SE, Glasziou P, Richardson WS, Haynes RB. Evidence-based medicine: How to practice and teach it, 4th ed. Churchill Livingstone, Elsevier: Edinburgh, 2011.
  3. Edwards P. A cabinet that looks like Canada:’ Justin Trudeau pledges government built on trust: Toronto Star Newspaper; 2015 [January 2017]. Available from: https://www.thestar.com/news/canada/2015/11/04/new-government-to-be-sworn-in-today.html.
  4. Malterud K, Bjelland AK, Elvbakken KT. Evidence-based medicine – an appropriate tool for evidence-based health policy? A case study from Norway. Health Research Policy and Systems. 2016;14(1):15.
  5. The JAMA Network. Evidence Based Medicine: An Oral History 2014 [January 2017]. Available from: https://ebm.jamanetwork.com/.
  6. The James Lind Library. Illustrating the development of fair tests of treatments in health care 2003 [January 2017]. Available from: https://www.jameslindlibrary.org/.
  7. Simpkin AL, Schwartzstein RM. Tolerating Uncertainty — The Next Medical Revolution? N Engl J Med 2016; 375(18):1713-1715.