Basic Steps

These basic steps in practicing Evidence Based Medicine are from the Pearls™ program of the College of Family Physicians of Canada.

1. Formulate a specific practice reflection question

• Identify a need for information
• The hardest part is admitting that you don't know the answer!
• State the need into one or more focused “searchable” questions
• The better the question, the easier the search

2. Search the literature to identify appropriate articles

• Search efficiently for the best available evidence on the subject
• The best evidence is from well-designed randomized controlled trials
• Some topics are not covered in the medical literature
• If so, then use the best available source of information – but be critical!
• Examples: Textbooks, medical colleagues, Internet

3. Critically appraise the information

• To critically appraise the evidence yourself is very time consuming
• Visit (internal link) Evidence Based Medicine (/link) to learn more about terminology
• The easiest statistical number to understand is the “number needed to treat” (NNT)
• Synopsis journals “provide further appraisal of articles”
• Example: the journal called Evidence Based Medicine

4. Make a practice decision based on the information

• Apply the information in your practice
• Every patient you treat could be considered a clinical trial (N of 1)
• Plan how to implement the change (involve your staff)
• A formal practice audit is one useful method

5. Evaluate the impact of the decision

• Evaluate the effect of the practice change
• After a reasonable interval (the CFPC suggests two months)
• Decide whether or not the change has been effective
• Decide if the “new way” is better than your “old way”