1. Introduction to Evidence Based Medicine
Loyola University Chicago
Stritch School of Medicine

2. Why EBM?
“Evidence based medicine is the basic science of clinical medicine.” - Vinay Prasad
“Student, you do not study to pass the test. You study to prepare for the day when you are the only thing between a patient and the grave.” (Dr. Mark Reid)
“A 21st century clinician who cannot critically read a study is as unprepared as one who cannot take a blood pressure or examine the cardiovascular system.”
BMJ 2008:337:

3. Evidence Based Medicine
“the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”
Sackett DL, et al. Evidence-based medicine: what it is and it isn’t. BMJ 1996;312:71-2.

4. Evidence Based Medicine
Patient
Values
Medical Decision
Clinical
Expertise
Research
Evidence
Integration of best research evidence with clinical expertise and patient values

5. 4 “As” of EBM Ask an answerable question Acquire the best evidence
Appraise the evidence for validity, clinical relevance and applicability
Apply the evidence

6. Answerable Questions Background Questions: Foreground Questions:
Who, what, where, when, why, how
“What causes shingles?”
Foreground Questions:
Related to patient care decisions and actions
PICO

7. PICO Formulate your clinical question: Patient or Population
Be specific
Intervention
Comparison Group
i.e. standard therapy, “gold standard”
Outcome of Interest
i.e. efficacy of therapy, mortality, specificity of diagnostic test
“Surrogate” outcomes

8. Common Types of Questions
Category
How common is the problem?
Prevalence
Is early detection helpful?
Screening
Is the diagnostic test accurate?
Diagnosis
What will happen without intervention?
Prognosis
Does this intervention improve outcomes?
Treatment
Is this intervention harmful?

9. Sources of Evidence
Quality

10. Why EBM? Clinical medicine: Does this practice improve my patient’s:
Making a diagnosis
Prescribing a treatment or performing a procedure
Providing a prognosis
Does this practice improve my patient’s:
Survival?
Health?
Quality of life?

11. Evidence Based Medicine
Patient
Values
Medical Decision
Clinical
Expertise
Research
Evidence
Integration of best research evidence with clinical expertise and patient values

12. Resources
Symptom to Diagnosis: An Evidence Based Guide, 3rd ed., Cifu et al.
Highly recommend!
Rational Medical Decision Making: A Case Based Approach. Rao, Gautham.
Ending Medical Reversal. Cifu, Adam & Prasad, Vinayak.