Literacy Skills for the Evidence-Based Medicine Practitioner

There was a time when clinical health practitioners (HPs)would likely not have to worry much about what kind of writing or reporting about writing they would have to do.  Yes, HPs had to read the practitioner literature and complete the requisite continuing education units to keep accreditation, but the degree to which HPs read -- or felt they had to read -- the research literature varied tremendously.  

The "times they are a'changin'", as they saying goes.

Now, there is a new model of HP literacy -- Evidence-Based Medicine (EBM), also called Evidence-Based Practice (EBP). Though there is some variation in what each term covers -- EBM more strongly connotes the medical research literature while EBP implies the use of the literature as it intersects clinical activities -- both require that the HP consult "evidence" when treating patients.

What is EBM/EBP?  "Evidence + Experience = Expertise"

The best known definition of EBM comes from Sackett et al., 1996, p.71 -- here's the main gist:

Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.

In essense, EBM states a good HP uses all the information available to them to make decisions when evaluating and treating patients.  This sounds pretty logical, doesn't it?  What kind of HP would not want to use the best combination of evidence (results from scientific study) and expertise (experience with actual patients)?  

In practice, though, EBM/EBP is tough -- as are most solutions to elegantly and simply stated problems. Challenges to implementing EBM include: 1) the aggregation of evidence into a form everyone can use; 2) the literacy skills required to use the aggregated evidence; 3) ways of making individual expertise available as consumable information; 4) working EBM strategies into an HPs work flow; and 5) systematic ways of taking patient preferences and values into account.  

This is the culture of health/medicine that you are moving into.  No medical field is immune to the pressures of EBM, and in 2009, the US government allocated considerable funds to solving the challenges mentioned above, especially the first one. To my knowledge, there is no systematic way of making individual expertise available as information or assessing patient preferences (though this is part of what practitioner-oriented journals provide); instead, health practitioners rely on an apprenticeship system by placing new clinicians in internships, externships, rotations, residencies, etc., to learn such skills before they can be fully independent.  But there is something we can do now about challenge #2, the literacy skills involved, and these can help considerably in addressing #4, incorporating EBM practices into your work flow as a clinician.  


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