Evidence-Based Medicine, Hierarchy of Evidence and Types of Research Studies
DNB Orthopaedics • May 2024 • Paper IV • 10 Marks • [(2+2)+6]
Introduction
Modern clinical decision-making should not depend solely on tradition, authority or individual experience. Evidence-based medicine (EBM) combines the best available research evidence with the clinician's expertise and the individual patient's values, circumstances and preferences.
Understanding different research designs is essential because different questions are best answered by different study types, and the probability of bias varies considerably between study designs.
EBM does not mean “following a paper blindly.” It means integrating best evidence + clinical expertise + patient values.
1. Definition of Evidence-Based Medicine
Evidence-based medicine is the conscientious, explicit and judicious use of the current best available evidence in making decisions about the care of individual patients, integrated with clinical expertise and patient values/preferences.
Best Evidence
Reliable and relevant clinical research.
Clinical Expertise
Clinician's judgement, experience and technical skill.
Patient Values
Goals, preferences, expectations and circumstances.
Steps of Practising EBM — The 5 A's
- Ask — formulate a focused clinical question.
- Acquire — search for the best available evidence.
- Appraise — assess validity, importance and applicability.
- Apply — integrate evidence with expertise and patient…