Residency Insight -- A PRESENT Podiatry eZine

Paul J Kim, DPM
Assistant Professor
Arizona Podiatric Medicine Program
Midwestern University College of Health Sciences

Last night's eZine by Jarrod really helped to put things into perspective on research and the clinical practice of medicine. I would like to continue on that theme and tonight provide this insight from Paul Kim regarding how we should define and view EBM as clinicians. After reading this, please send us a note or post on the linked eTalk to share your thoughts on how we put this all together…" —John Steinberg, DPM

Simplifying Evidence Based Medicine

There has been much written in the past several years regarding Evidence Based Medicine (EBM). Largely, because of the perceived complexity of this topic, people have focused on defining EBM. This has been helpful in educating people in the EBM technique. Unfortunately, the term has occasionally been hijacked and has been used inappropriately to defend or advance a particular idea, treatment or process. For example, I have read articles that use the term EBM to describe what in reality is no more than a literature review. Further, the term EBM has been used in the title or in the body of a text to legitimize or validate a particular argument, even though EBM has not been utilized. This results in further confusion as to what EBM really is. Hence, I have listed as succinctly as possible what EBM is and what it is not:

What it is:

1. A structured tool to answer a relevant clinical question for a specific patient with a specific problem.
2. Meant to be used by a clinician in everyday practice.
3. A process of asking a clinical question for a specific patient, conducting a literature search, selecting the best evidence, evaluating the best evidence, and formulating a treatment plan based on the best evidence.

What it is not:

1. A stand alone literature review that is used to support a general idea or concept.
2. The use of complicated, statistical analysis, hence out of reach for the typical clinician.
3. A cumbersome tool that takes too long to apply.
4. Applicable to any patient, in all situations.
5. Disregards the specific patient’s unique values and circumstances.
6. Disregards the specific clinician’s experience and expertise.

The details of utilizing the EBM process is out of the scope of this editorial, but the above will hopefully help to clarify some misconceptions. It is important to note that clinical questions do not always have evidential support in the peer reviewed literature. Therefore, it is important to also rely on one’s clinical experience for the best results. On the other hand, the advancement of medicine relies on adding to the body of evidence. Therefore, further research should be encouraged to seek out new information and challenge dogma. This will ultimately result in better patient outcomes. The challenge is then to inculcate the EBM approach to all clinicians. This is in part achieved through decreasing the confusion over EBM. I encourage everyone to study EBM and utilize it in everyday practice. It is never too late to learn.

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