EBM- Introduction Michael C. Koester, MD, ATC April 5, 2006

EBM- Introduction EBM requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances. best research evidence- valid and clinically relevant research. clinical expertise- use of clinical skills, experiences patient’s values- preferences, concerns, and expectations. patient’s circumstances- clinical state and setting

EBM- Introduction Term coined in 1992 4 realizations Medline hits 1992- 1 Medline hits 2004- Over 13,000 Medline hits March 2006- 20,763 4 realizations Daily need for valid info Inadequacy of traditional sources Skills improve with age, performance and knowledge decline Little time to improve knowledge

EBM- Introduction 5 developments Strategies to efficiently track and appraise evidence Creation of systematic reviews Creation of EBM summaries Creation of information systems Identification and application of effective strategies for learning and improving performance

EBM- Introduction How do we practice EBM? Step 1- Form the clinical question Step 2- Find the evidence Step 3- Critically appraise the evidence Step 4- Integrate the evidence with practice Step 5- Evaluate the effectiveness and efficiency of steps 1-4 and attempt to improve

EBM- Introduction “Levels” of EBM practice- Doing- Steps 1-4, at least Using- All but step 3 Replicating- abandoning at least steps 2 and 3 Level of practice may conform to how frequently you encounter the clinical question.

EBM- Introduction Use of CAT’s and brief summaries will likely improve the practice of EBM among practicing clinicians. The “E” for EBM is difficult to define and more difficult to obtain. Hard to measure changes in attitudes and behaviors Unethical to do RCT’s to look at outcomes Can “lifelong learning” be measured short-term? Limitations- must answer critics concerns regarding “cookbook” approach, cost savings, ivory tower concept, time limitations, etc. Must develop and apply these clinical skills within the time constraints of clinical practice