The Evidence Cycle
Image from the Duke University EBP guide
The patient is at the center of evidence-based medicine decision-making.
- Assess the patient with a thorough clinical evaluation to gather all the pertinent data about the patient(s) or population(s)
- Ask patient-oriented, relevant, answerable questions about the health status and context of patients or populations
- Acquire the best available evidence to answer the question
- Appraise the evidence critically for validity and applicability to the problem at hand
- Apply the evidence by engaging in collaborative health decision-making with the patient(s) or population(s)
Evidence cycle description from the Duke Program on Teaching Evidence-Based Practice
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What is Evidence Based Medicine?
Image from the Duke University EBP guide
Evidence-based medicine (EBM) is the integration of best research evidence with clinical expertise and patient values.
- by best research evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. New evidence from clinical research both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.
- by clinical expertise we mean the ability to use our clinical skills and past experience to rapidly identify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations.
- by patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.
Straus, S. E., Glasziou, P., Richardson, W. S., & Haynes, R. B. (2019). Evidence-based medicine: How to practice and teach EBM.
Overviews/Tutorials
- An Introduction to Evidence Based PracticeThis self-paced, interactive tutorial will take you through the complete EBP process, emphasizing the elements of a well-built clinical question and the key issues that help determine the validity of evidence. This program was developed by the Medical Center Library at Duke University and the Health Sciences Library at the University of North Carolina at Chapel Hill.
- Centre for Evidence-Based MedicineEBM guides and practical how to's for researchers, clinicians, students and teachers
- Evidence Based Medicine: Learning ModulesLamar Soutter Library, UMass
EBM Toolkits
- American Family Physician EBM ToolkitResources and information on SORT
- BMJ Best Practice EBM ToolkitResources to learn the key aspects of EBM and tools for practice.
EBM Books & Glossaries
EBM Books
- Users' guides to the medical literature: a manual for evidence-based clinical practice, 3rd ed.Guyatt, Gordon, Rennie, Drummond, Meade, Maureen, and Cook, Diane, eds. AMA Press; 2015.
Available online for UW students and staff. - Users' guides to the medical literature: essentials of evidence-based clinical practice, 3rd ed.Guyatt, Gordon, Rennie, Drummond, eds. AMA Press; 2015.
Ebling Library reserves - How to read a paper: the basics of evidence-based medicineTrisha Greenhalgh. Wiley Blackwell; 2020.
Available online for UW students and staff. - Evidence-based medicine: how to practice and teach EBM, 5th ed.Straus, Sharon E. Elsevier; 2019.
Available online for UW students and staff. - 50 studies every doctor should know: the key studies that form the foundation of evidence based medicineHockman, Michael, ed. Oxford University Press; 2014
Ebling Library stacks - Effectiveness and efficiency: random reflections on health servicesCochrane, A.L. Nuffield Provincial Hospitals Trust; 1972.
Ebling Library stacks - Knowledge translation in health care: moving from evidence to practice, 2nd ed.Straus, Sharon E., Tetroe, Jacqueline, Graham, Ian D., eds. Wiley; 2013.
Available online for UW students and staff
EBM Glossaries