Steps to Evidence-Based Medicine

The MD Program curriculum at the University of Wisconsin School of Medicine and Public Health in Madison includes training in evidence-based medicine (EBM). The following are steps to evidence-based medicine.

Step 1: Define a Clinical Question

Formulating Answerable Clinical Questions (Centre for Evidence-Based Medicine)

Step 2: Find the Evidence

Use the terms from your PICO question to search a current literature database. When using PubMed, the easiest approach is to insert the most important words from your question with and between each one.

Use the Clinical Queries section of PubMed to search for evidence.

If you are not familiar with searching in PubMed, work through the National Library of Medicine's online tutorial or contact the medical education liaison librarian at esevetson@library.wisc.edu.

If Your Search Yields Too Much Information, Try These Approaches

• Make sure you are using the "specificity" button with either the "diagnosis" or "therapy" button
• Add in further search terms with other words of your PICO question
• Use the limits available when searching

If Your Search Yields Too Little Information, Try These Approaches

• Use the "sensitivity" button with either the "diagnosis" or "therapy" button
• Remove some of the search terms from your entry
• Remove limits from your search

Advice on Choosing an Article

Sometimes more than one article fulfills your criteria. With quick review of the abstract you can usually eliminate some of the articles. We suggest you choose an article that:

• Is recent
• Indicates the study is conducted in a blinded fashion
• Clearly compares your diagnostic test or therapy in question to a reference standard
• Comes from a reputable journal 

Step 3: Assess the evidence

Critical Appraisal of the Evidence: After finding either diagnosis or therapy evidence, decide whether it is both valid, or close to the truth and important, or will make a difference in patient care. The order in which validity and importance are considered depends on individual preference, but both should be addressed before deciding whether the evidence can be applied to individual patients.

• Diagnosis (Centre for Evidence-Based Medicine)
• Therapy (Centre for Evidence-Based Medicine) 

Step 4: Apply the Evidence

Applying Evidence to Patients (Centre for Evidence-Based Medicine)

Step 5: Communication

Finding and evaluating clinical information is only part of EBM. It is equally important to be able to communicate this information to patients and to integrate patient values and preferences in decision-making¹. These skills will become more important as external forces, such as managed care, direct-to-consumer advertising and Internet-accessible patient information, become greater factors in doctor-patient interactions. In Patient, Doctor and Society 4, you will be learning and practicing these important skills.

1. McAlister FA, Straus SE, Guyatt GH, Haynes RB for the Evidence-Based Working Group. User's guide to the medical literature: XX. Integrating research evidence with the care of the individual patient. JAMA. 2000;283(1):2829-36.