Principles of evidence based medicine - PubMed

EBM can be practiced in the following steps:

1. Formulating answerable clinical questions
2. Finding the evidence
3. Appraising the evidence
4. Applying the evidence
5. Evaluating performance 

A problem cannot be solved without a solution - and a solution start with a question.

It is often difficult to translate a clinical problem into a answerable question. However, it is good practice to be able to convert our information needs into answerable questions. Use the following acronym to construct an answerable clinical question: PICO

• Patient or Problem: 4 month old baby with viral bronchiolitis 
• Intervention, test or exposure of interest: corticosteroids
• Comparison interventions (if relevant): no corticosteroids
• Outcomes of interest: clinical score, length of hospital stay

Once the question is compiled, one must seek relevant evidence that will help answer this question. 

Source of information include:

• Textbooks and journals (although often disorganized or out of date)
• Colleagues of experts in the field
• Secondary sources of reliable summarized evidence (Archimedes, Clinical Evidence, BestBets)
• Online electronic bibliographic databases (Cochrane Library databases, MEDLINE, EMBASE, CINAHL) 

Remember to generate appropriate keywords for your searches and to use the Boolean operators "AND" and/or "OR" to combine or refine searches. 

Relevant articles should always be appraised for its validity, clinical usefulness, importance and applicability to the patient/patients of interest.

This is often a skill and involves learning how to ask a few key questions regarding the validity of the evidence and it relevance. This will come with more experience as a doctor and by attending specific workshops. 

After appraising for the validity and importance of our evidence, we need to decide whether the evidence can be applied to our patient or population. 

A very important step in this process is keeping in mind the patient's individual personal values and circumstances when making the decision< the risks and efficacy of the evidence should be discussed with the patient and family at length to allow them to make an informed decision. 

The costs and availability of resources in your local hospital or practice should be kept in mind if the evidence is applied. 

Not only after, but during our incorporation of EBM into routine clinical practice we should constantly be evaluating our approach at frequent intervals. Areas of improvement at each step of the process should be noted as well