What is EBM?
Evidence Based Medicine (EBM) is an approach to forming medical knowledge, based on systematic and unbiased methods of appraising scientific evidence (Source: BestBETs).
The Key Steps in Evidence Based Practice (EBP)
Evidence-based practice (EBP) is the inclusive term which the principles of EBM are founded; primarily EBP is based on five well defined steps.
Step One: Asking Focused Questions
One of the fundamental skills required for practising EBM is the asking of well-built clinical questions. To benefit patients and clinicians, such questions need to be both directly relevant to patients' problems and phrased in ways that direct your search to relevant and precise answers. In practice, well-built clinical questions usually contain the four PICO elements (Source: Centre for Evidence Based Medicine). For more information on PICO visit our PICO guide.
Step Two: Finding the Evidence
It is important when searching for evidence that search terms are referred back to your original PICO question. The type of evidence located may include:
When forming your question think of alternate keywords, including alternate spelling and terms for example:
You also need to think about the following:
Step Three: Appraising the Evidence
The purpose of critical appraisal is to determine the relevance of the material collected in relation to the clinical question raised. In other words, does the evidence provide the answer to the question raised and how confidently can the evidence be applied to practice? (Source: Cleary- Holdforth J, Leufer T, 2008 ‘Essential elements in developing evidence-based practice' Nursing Standard. 23, 2, 42-46)
Step Four: Applying the Evidence
Once the evidence has been appraised, and the best available evidence selected, it must be applied to your local situation. How it is applied will depend on its relevance to local conditions. Below is a list of questions you may ask to help determine how evidence applies:
Applicability may be determined by the following variables listed in the checklists below:
Step Five: Evaluating Performance
To complete the cycle of practising evidence based medicine clinicians should evaluate their own performance, and this fifth step of self evaluation allows clinicians to focus on earlier steps that may need improvement in the future. Clinicians can evaluate their progress at each stage by asking some or all of the following questions:
(Source: Straus, E and Sackett D L 1998, ‘Getting research findings into practice Using research findings in clinical practice' BMJ Vol.317 p.339-342; Johnson, C 2008, ‘Evidence-based practice in 5 simple steps' Journal of Manipulative and Physiological Therapeutics Vol. 31 p.169-170).