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Evidence-Based Medicine: Overview

What is Evidence-Based Medicine?

Evidence-Based Medicine (EBM) is the integration of best research evidence with clinical expertise and patient values. (Sackett DL, Straus SE, Richardson WS, et al.Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000.).  Evidence-Based Medicine (EBM) can also be referred to as Evidence-Based Practice (EBP) or Evidence-Based Research (EBR).

What is Evidence-Based Medicine (EBM)?

Evidence cycleThe steps in the EBM process should always begin and end with the patient.  It is a patient-centered care model and is typically initiated during clinical encounters with patients where questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, or the etiology (harm) of diseases arise.

The following information and images are combined from Duke University Medical Center Library & Archives' guide on Evidence-Based Practice and Georgetown University Medical Center's Evidence-Based Medicine Resource Guide.

The 5 A's of the Evidence-Based Cycle:

Asses your patient

The clinician must assess the patient and the problem to determine the pertinent issues, which may include a differential diagnosis, treatment decisions, or prognosis.

Ask an answerable, well-built clinical question

The clinician must draw from this evaluation and ask a clear, answerable question to be pursued.

Acquire the evidence in the healthcare literature

The next step is to efficiently acquire the evidence from an appropriate source.  Potential sources include original research studies, systematic reviews, evidence-based journal abstracts, textbooks and computerized decision support systems.

Appraise the evidence for it's validity and acceptability

With a potential source in hand, the clinican must appraise the evidence to further examine its worth and reliability.

Apply the evidence to patient care

This process must conclude by returning to the individual patient, as the clinician has to decide whether it is appropriate to apply the evidence to the particular patient and their unique values and circumstances.  Evidence alone is never sufficient to direct decision making.  Rather, it must be put into context with a patient's values.

For more information on the 5 A's, see the following document:

Medical research is a structured method of measuring and evaluating outcomes of various procedures, practices, hypotheses, etc. If one discovers a significant, proven result that can be replicated by others, and this result is better than current/customary practice, the new findings may be incorporated into everyday practice and is then referred to as Evidence Based Practice (EBP).  The evidence is the result(s) and conclusion of the research. Medical practice is based on this evidence showing the effectiveness of a particular practice.

Is it Evidence-Based Research?


The original peer reviewed scholarly study or work was conducted by the author(s) using the scientific method of research.

It will usually contain the phrase, "the purpose of this study..."

The articles will contain the following sections:

  • Abstract, Purpose, Introduction, Summary (essential)
    "The purpose of this (pilot) study is……..”
  • Literature Review (optional) 
  • Method/Design (essential)
  • Data (essential)
    • Tables
    • Graphs
    • Charts
  • Results (essential)
  • Discussion (essential)
  • Directions for Further Research (or similar)
  • Conclusion (essential)
  • References (essential)

Evidence-Based Practice Step by Step

The following is a list of articles originally published in American Journal of Nursing as a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice.

A note about these types of studies:  

  • Research may be one or the other, but an author may never use the words qualitative (behavior, feelings, etc.) or quantitative (counting, numbers, etc.) in the article, and
  • You may have to determine for yourself which type of study it is.

Check the links below for more comparisons:

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