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Experience-Based, Integrative Evidence-Based Medicine (EBM)
Evidence-Based Medicine (EBM) is both a “content area” and a “process” for teaching and practicing medicine. As a content area, residents must learn to become proficient in the basic skills of framing testable questions, searching for best evidence, and critically appraising that evidence. To fully utilize EBM as a method for teaching and practicing medicine, residency faculty must model EBM when treating patients and when discussing patient care with residents during clinical experiences. There have been criticisms of the EBM movement for ignoring both the wisdom of experience and the wishes of the patient. In their second edition, Sackett et al. defined EBM as an “integration of best research evidence with clinical expertise and patient values.” This definition promotes the use of evidence and “informed opinion” in the unique context of the needs of the individual patient. The following key characteristics of Integrative, Evidence-Based Medicine are consistent with the characteristics of “Teaching from a Competency Perspective.”
- On-line modules and journal club activities can be effective, efficient techniques for teaching the basics of EBM. For EBM to become a part of residents’ approach to practicing medicine, however, it must be integrated into the daily routine of examining and evaluating patients. (Explicit and Real-Life)
- Modeling an evidence-based approach to practicing medicine fosters the critical appraisal of personal assumptions as well as the framing and testing of good clinical questions that ultimately guide practice. (Self Assessment)
- Learning to practice medicine using an EBM approach includes learning how to weigh the value of clinical experience, patient values, and best evidence. It also includes learning what to do when “best evidence” is not very enlightening. (Real-life)
- As defined above, EBM fosters accountability, as the integration of “documented best practice” and expert clinical opinion become the criterion set for patient care. (Accountability)
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