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

2. 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

3. EBM- Introduction Term coined in 1992 4 realizations
Medline hits
Medline hits Over 13,000
Medline hits March ,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

4. 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

5. 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

6. 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.

7. 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