If you are looking for a more comprehensive, in-depth lesson on evidence-based practice, please visit our advanced tutorial.
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While we mainly talk about it with healthcare, the core concepts can be used in any profession.
After completing this tutorial, you will be able to:
Identify what EBP is and why it is important
Define the strategies that exist for EBP
Recognize the 5 steps of EBP
Demonstrate how to ask an answerable question
Categorize appropriate sources of information
What is Evidence-Based Practice (EBP)?
Why is EBP Important?
Overview of The 5 Steps of EBP
Asking a Well-Built Question
Acquiring Resources
Test Your Knowledge
Clinical expertise - the provider’s judgement about what works best in similar patients or in similar situations.
Research evidence - the results of scientific studies to find out which treatments, diagnostic methods, or ways of predicting a patient outcome work best.
Patients needs/values - what is important for the patient and what healthcare options best match those values.
So why is this important? Let's look at three reasons why.
Through years of practice, healthcare providers develop clinical expertise that guides patient care decisions.
This clinical judgement is essential for applying evidence-based practice.
Research evidence can provide a higher-level view than expert opinions or objective data to help inform healthcare decisions, and is one of the important pieces of evidence-based practice.
Cost of care, quality of life, and personal beliefs are all important considerations.
Patients should be partners in their care and help decide what type of healthcare is best for them.
Evidence-based practice recognizes that patient values are essential in determining care.
There are five steps of evidence-based practice that provide a framework for approaching a question.
Step 1: Ask a well-built question
Step 2: Acquire evidence
Step 3: Appraise the evidence
Step 4: Apply the evidence along with clinical judgement and patient values
Step 5: Assess the results
When you are presented with a patient case, there is usually a flood of details to digest.
To effectively search for the best evidence, you first need to decide what details are important.
For example:
One strategy for creating a well-built clinical question is to use the PICO method.
PICO is a mnemonic device that helps us focus on the most important information in a case and formulate a question for searching.
P: The patient’s disorder or disease or problem of interest
I: The intervention or finding under review
C: A comparison intervention (if applicable - not always present)
O: The outcome
Let's take a look at a few clinical scenarios and how we would break these into PICO.
Problem: 65 year-old man with high cholesterol
Intervention: Red rice yeast
Comparison: Statin drug
Outcome: Lower cholesterol
Problem: 50 year old man with history of low back pain
Intervention: Physical therapy
Comparison: Surgery
Outcome: Pain relief
Problem: 34 year-old woman with cold sores
Intervention: Zinc
Comparison: No treatment
Outcome: Prevention of cold sores
For example:
In a 65 year old man with high cholesterol, is red yeast rice as effective at lowering cholesterol as a statin drug?
In a 50 year old man with low back pain, is physical therapy as effective at relieving pain as surgery?
In a 34 year old woman with cold sores, does taking zinc work help to prevent cold sores?
There are several different categories of information and different questions are often suited to different categories of information.
Background Resources: Provides an overview of a topic
Synthesized Resources: Appraises and summarizes studies (primary sources)
Primary Sources: A single research study that tries to answer a specific question
Strengths:
A summary on an entire topic, good for definitions and getting up to date quickly on history and best practices. Good for if you unfamiliar with a topic
Weaknesses:
May not include the most current evidence on a topic
Examples:
Review Articles or Textbooks like Harrison’s Principles of Internal Medicine or Williams’ Gynecology
Strengths:
More current than background sources, summarize other articles, built by experts following a systematic method
Weaknesses:
May not exist for every topic or question, may not include the latest information
Examples:
DynaMed Plus, Micromedex or Cochrane Library's systematic reviews
When synthesized information is not available for a question, you should turn to the primary literature. These research study articles provide the most current and most detailed information.
Strengths:
Most current, most specific, level of detail allows methods to be examined
Weaknesses:
Time consuming to find and critique, more open to bias
Examples:
Journal articles in databases like PubMed, CINAHL, or Embase
What evidence-based practice is and why it is important?
What strategies exist for evidence-based practice?
The five steps of evidence-based practice?
How to ask an answerable question?
The three types of sources of information dentifying appropriate sources of information?
Visit the module Step 3: Critical Appraisal to continue learning the steps of EBP.
Lindsay Matts-Benson and Andrew Palahniuk from the University of Minnesota Libraries Instructional Design Team provided Instructional Design support.
Contact the Biomedical Library staff if you have any additional questions about the content in this tutorial.
The content in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Images © 2016 Regents of the University of Minnesota. All rights reserved.