The resources and tools below can help with the learning, teaching and application of evdience based practice. Materials and worksheets are to be used with proper attribution to their creators.
On this page
1. What is Evidence - Based Practice?
Evidence Based Medicine (EBM),Evidence-based practice (EBP) and evidence-based health care (EBHC) refer to similar processes of (patient centered) inquiries seeking to increase effectiveness and efficiency in health care based on answers from unbiased scientifc literature. EBM is defined as “theintegration of best research evidence with clinical expertise and patientvalues.” -- Sackett, D. L. (1997).
Evidence-Based Practice: a five-step process
- ASK: Converting information needs into focused questions.
- ACQUIRE: Efficiently tracking down the best evidence with which to answer the question.
- APPRAISE: Critically appraising the evidence for validity and clinical usefulness.
- APPLY: Applying the results in clinical practice
- ASSESS AND ADJUST: Evaluating performance of the evidence in clinical application.
What is EBM? Centre for Evidence-based Medicine (CEBM) at the University of Oxford.
2. Asking the Clinical Question
Clinical questions should be directly relevant to the problem at hand, focused, and phrased to facilitate searching for a precise answer
PICO offers a structure for formulating clinical questions.
P= Patient, population, or problem
I = Intervention, prognostic factor or exposure
C = Comparison (baseline or placebo)
O = Outcomes to measure or be achieved
Template for Formulating the Question - PICO (pdf) - Dartmouth Biomedical Library
Understanding Research Study Designs - University of Minnesota Libraries
Types of Questions and Types of Research Study Designs (pdf) – Yale and Dartmouth
Best evidence by type of Question (pdf) - McGill University Library
Levels of Evidence (2011) - Oxford Centre for Evidence-Based Medicine
Levels of Evidence - Is All Evidence Created Equal? - University of Illinois at Chicago Library
3. Acquiring the evidence (Searching the EBM Literature)
Hierarchy of evidence: the EBM evidence pyramid
EBM Pyramid handout (levels of evidence/study type/Resources) (pdf) - Dartmouth EBM Institute
EBM Resources Summary Psychiatry 2013 (doc) - JGH and McGill Libraries
Bryan Haynes 6S model (pdf) - (McGill University Library adaptation)
Systems, Summaries, Synopsis of synthesis, Synthesis, Synopsis of studies, Studies
3a. "Filtered Information"
Synthesis of Information: Systematic Reviews/Meta-Analysis
An electronic library of independent, high quality evidence for healthcare decision making. It includes seven databases, most importantly the Cochrane Database of Systematic Reviews (CDSR) which contains over 7000 reviews of which more than 400 are on topics in Mental Health.
Contains over 18,000 structured abstracts of systematic reviews from a variety of journals.
Summaries: Critically Appraised Topics
"A frequently updated compendium of evidence on the effects of common clinical interventions based on thorough searches of the literature. It provides a concise account of the current state of knowledge, ignorance, and uncertainty." Includes patient information.
"UpToDate allows clinicians to search by disease, symptom, lab abnormality, procedure, or drug, and find information based on the latest evidence". It includes information for patients.
CMA Infobase: clinical practice guidelines -- Canadian Medical Association
Synopsis of Studies (Critically Appraised Individual Articles)
Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. It surveys over 100 international journals and summarises studies of high relevance and methodological quality. Published quarterly by the BMJ group.
Complements the BMJ Clinical Evidence for current research. Research articles are selected from over 110 clinical journals covering all medical specialties and rated for clinical interest and relevance. Sign up to receive regular alerts by e-mail.
Clinical Queries Filters
These are pre-set filters for selecting methodologically sound studies. Available when searching MEDLINE, PsycInfo, EMBASE, CINAHL as Limits on different search platforms (OVID, EBSCO).
Filtered retrieval of clinically sound studies from MEDLINE for therapy, diagnosis, etiology, prognosis and clinical prediction guides (tests, validation).
3b. "Unfiltered Information" Primary Research Studies databases
MEDLINE is the premier biomedical database containing over 20 million indexed citations. It covers over 5500 international journals in medicine, dentistry, veterinary medicine, healthcare, preclincial sciences and more.Medline is freely-searchable at PubMed http://pubmed.gov, and available by subscription via OvidSP.
PubMed comprises more than 22 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central ('NIH repository for peer-reviewed primary research reports in the life sciences.') and publisher web sites. It includes not yet indexed literature (PubMed in process) as well as out of scope citations.
Major biomedical and pharmaceutical database covering drug research, pharmacology, pharmaceutics, toxicology, clinical and experimental human medicine, health policy and management, public health, occupational health, environmental health, drug dependence and abuse, psychiatry, forensic medicine, and biomedical engineering/instrumentation. Produced by Excerpta Medica and updated weekly. Indexing of over 3,500 international journals.
International coverage of the professional and academic literature in psychology, medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and other areas.
Cumulative Index to Nursing and Allied Health Literature.
To limit your CINAHL search to the best evidence-producing studies: Click on the "Limits" icon to use "Clinical Queries" or limit to "Research" or other "publication" types (i.e., systematic review).
PsychiatryOnline: includes the DSM-IV-TR®, Handbooks, Textbooks but also Guidelines and Journals published by the American Psychiatric Association.
3c. Meta-Search Engines
TRIP Database (Turning Research into Practice):
A meta-search engine that searches simultaneously evidence-based sources of systematic reviews, practice guidelines, critically-appraised topics and articles -- including most of those listed above -- individual studies, patient information and more. Also searches MEDLINE's Clinical Queries, medical image databases, e-textbooks, and patient information leaflets.
4. Appraising the Evidence
Filtered information has already been put through a critical appraisal process. When the best evidence for your question is unfiltered, before you put the evidence into practice, you will need to critically appraise it to ensure that it is both useful and valid.
Critical Appraisal tools - Centre for Evidence-Based Medicine
Critical Appraisal tools - JAMA Evidence
Critical Appraisal tools- Dartmouth College
Risk Reduction calculator- from Alan Schwartz at the University of Illinois, Chicago.
Diagnostic Test Calculator - from Alan Schwartz at the University of Illinois, Chicago.
5. Other Useful EBM Resources
More EBM information sources
from Dean Giustini
Evidence-based Answers to Clinical Questions for Busy Clinicians (2011) (pdf)
Centre for Clinical Effectiveness (CCE), Monash Medical Centre, Australia: A free, user-friendly EBM workbook
Evidence at Becker Library Subject Guide
Washington School of Medicine, St Louis Missouri. How To: Search the Literature, Appraise the Literature, EBM Calculators and Tutorials.
Research and Subject Guides. Evidence Based Medicine
University of Illinois at Chicago UIC Library. Practical guide designed to assist health care professionals and students become effective and efficient users of the medical literature. Includes Clinical Search filters, useful terms for MEDLINE EBM searching and Library Tutorials (What is EBM, PICO).
Glossary of EBM Terms – from the Centre for Evidence Based Medicine – Toronto
Library Video Tutorials
Find It Fast! - Yale University