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EBM is the integration of evidence, clinical expertise, and patient values and preferences. Factors influencing clinical expertise include judgement, clinical skills and personal experience. EBM requires life-long self-monitored learning to stay up-to-date with the most recent clinical interventions and techniques, as this information is constantly changing.
EBM aims to improve patient care quality and produce optimal patient outcomes. It is identifying and promoting clinical practices that work, and eliminating those that don't. Additionally, the precision, accuracy and power of the intervention must be critically assessed. This process furthers the development of critical thinking.
According to AK Akobeng, there are five main steps to properly practise EBM. The next few blocks will explore this concept.
Formulate Answerable Clinical Questions (CQs)
The key is to translate the clinical problem into an answerable clinical question (CQ) – e.g. “Is treatment A effective in irradicating disease B?”. CQs should be clear, focus directly on the presenting complaint, and be answerable in terms of clinical evidence available.
Form clinical questions using the PICO method.
“P” - the Patient themself and the Problem i.e. their medical history and presenting complaint.
“I” - Intervention i.e. the treatment / test used.
“C” - Comparison of various interventions.
“O” - Outcome i.e. the predicted result.
Find the Evidence : Source
Look for evidence that will answer your CQ. Clinical databases (e.g. Archimedes) are relatively reliable and timesaving sources, compared to traditional textbooks and oral sources. The Cochrane Database - a collection of system reviews - is also widely used in the medical field.
Find the Evidence : Search
Being able to search these databases is another skill in and of itself. Firstly, extract keywords from your PICO framework e.g. Problem is Thrombosis and Intervention is Aspirin, therefore the search will include the words “Thrombosis Aspirin”. When conducting the search, use the operating word “AND” for search results including all keywords and “OR” for either/some of the keywords.
Appraise the Evidence
Not all research evidence is made the same – some is high-quality and thorough, some isn’t. It is thus paramount that research evidence is appraised in terms of validity, importance, and applicability. The CASP (Critical Appraisal Skills Programme) tools developed by Oxford Univ. incorporate all of these factors and provide a framework for your appraisal.
Apply the Evidence
Establish the efficacy, risks, availability, and cost of the proposed treatment/test/intervention, and discuss with the patient before proceeding. This establishes trust between the health care practitioner and the patient - a "therapeutic alliance" as Akobeng says.
Self-monitoring and -auditing are fundamental in EBM practice. Ask yourself, "Am I following all 5 steps to the best of my ability?". This ensures that you are always providing the best possible patient care, and that favourable patient outcomes are strived for and ultimately, achieved.
A comprehensive summary of AK Akobeng's article on the Principles of Evidence Based Medicine.
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