Physicians are faced with the task and responsibility of determining the best treatment for their patients. However, a number of factors can influence the decision and it can be a daunting task to determine what is ‘best’. What is the best way to approach finding the solution? Where to look, and what matters more? In 1992, McMaster University researchers described ‘a shift in medical paradigms’ known as evidence-based medicine (EBM). In January 2007, readers of the British Medical Journal nominated EBM as one of the top 15 most important medical breakthroughs. EBM is internationally known and is becoming increasingly more important in clinical decision-making schemes worldwide.
What are the defining principles of EBM?
- EBM describes a set of practices to help solve clinical problems
- Essentially, EBM encourages physicians to use the best available evidence to inform clinical decisions
- Evidence takes the form of published literature, or unpublished personal observations
- There is a hierarchy to the quality of different types of evidence (i.e. RCT is better than an observational study to compare the effectiveness of two different clinical interventions)
- Physicians must evaluate all evidence (including direct patient observation) to determine what intervention is best for the patient
- Evidence is not enough: physicians must also incorporate patient values and preferences into the decision
What are the benefits of EBM?
- Forgoes reliance on consensus and past practice in favour of empirical evidence to inform clinical decisions
- Raises awareness of the difference between a well-informed and less well supported clinical decisions
- Provides a guideline to determine which evidence should be given greater consideration, and under what circumstances
- Improves clinical outcomes by combining evidence from patient observation with current medical literature
- The EBM philosophy is cross-disciplinary: the concept has been applied to such diverse fields as nursing and public policy
Knowledge Translation at McMaster
EBM is an application of knowledge translation by McMaster researchers that has had a global impact. At its core, EBM is about improving the use of research evidence by physicians. This is fundamentally a knowledge translation activity; it is research on how to best encourage and improve the flow of information to physicians, with the aim of informing clinical decisions. EBM highlights the critical importance of KT activities and shows the tremendous impact that can be realized by more effectively utilizing and communicating existing knowledge.
Gordon Guyatt <firstname.lastname@example.org>