Evidence-based Medicine Toolkit

2 Evidence-based Medicine ToolkitThis ‘toolkit’ is designed as a summary and reminder of the keyelements of practising evidence-based medicine (EBM). It haslargely been adapted from resources developed at the Centre forEvidence-based Medicine. For more detailed coverage, you shouldrefer to the other EBM texts and web pages cited throughout.The first page of each chapter presents a ‘minimalist’ checklist ofthe key points. Further sections within each chapter address thesepoints in more detail and give additional background information.Ideally, you should just need to refer to the first page to get thebasics, and delve into the further sections as required.Occasionally, you will see the dustbin icon on the right. Thismeans that the question being discussed is a ‘filter’ question forcritical appraisal: if the answer is not satisfactory, you should considerditching the paper and looking elsewhere. If you don’t ditchthe paper, you should be aware that the effect it describes may notappear in your patient in the same way.Definition of evidence-based medicineEvidence-based medicine is the ‘conscientious, explicit and judicioususe of current best evidence in making decisions about individualpatients’.This means ‘integrating individual clinical expertise with thebest available external clinical evidence from systematic research’(Sackett et al. 2000).We can summarize the EBM approach as a five-step model:1 Asking answerable clinical questions.2 Searching for the evidence.3 Critically appraising the evidence for its validity and relevance.4 Making a decision, by integrating the evidence with your clinicalexpertise and the patient’s values.5 Evaluating your performance.