Health Policy, Anglia and Oxford Regional Health Authority, Oxford OX3 7LF Correspondence to: Dr Rosenberg. Doctors within the NHS are confronting major changes at work. While we endeavour to improve the quality of health care, junior doctors' hours have been reduced and the emphasis on continuing medical education has increased. We are confronted by a growing body of information, much of it invalid or irrelevant to clinical practice. This article discusses evidence based medicine, a process of turning clinical problems into questions and then systematically locating, appraising, and using contemporaneous research findings as the basis for clinical decisions. The computerisation of bibliographies and the development of software that permits the rapid location of relevant evidence have made it easier for busy clinicians to make best use of the published literature. Critical appraisal can be used to determine the validity and applicability of the evidence, which is then used to inform clinical decisions. Evidence based medicine can be taught to, and practised by, clinicians at all levels of seniority and can be used to close the gulf between good clinical research and clinical practice. In addition it can help to promote self directed learning and teamwork and produce faster and better doctors. Doctors must cope with a rapidly changing body of relevant evidence and maximise the quality of medical care despite the reduction in junior doctors' working hours and scarce resources. We are deluged with information, and although much of it is either invalid or irrelevant to clinical practice, an increasing amount comes from powerful investigations such as randomised controlled trials. Yet we continue to base our clinical decisions on increasingly out of date primary training or the overinterpretation of experiences with individual patients, 1 and even dramatically positive results from rigorous clinical studies remain largely unapplied. 2 Doctors need new skills to track down the new types of strong and useful evidence, distinguish it from weak and irrelevant evidence, and put it into practice. In this paper we discuss evidence based medicine, a new framework for clinical problem solving which may help clinicians to meet these challenges. Evidence based medicine is the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions. For decades people have been aware of the gaps between research evidence and clinical practice, and the consequences in terms of expensive, ineffective, or even harmful decision making. 3 4 Inexpensive electronic databases and widespread computer literacy now give doctors access to enormous amounts of data. Evidence based medicine is about asking questions, finding and appraising the relevant data, and harnessing that information for everyday clinical practice. Most readers will recognise that the ideas underlying evidence based medicine are not new. Clinicians identify the questions raised in caring for their patients and consult the literature at least occasionally, if not routinely. The difference with using an explicit, evidence based medicine framework is twofold: it can make consulting and evaluating the literature a relatively simple, routine procedure, and it can make this process workable for clinical teams, as well as for individual clinicians. The term "evidence based medicine" was coined at McMaster Medical School in Canada in the 1980s to label this clinical learning strategy, which people at the school had been developing for over a decade. Evidence based medicine in practice Evidence based medicine can be practised in any situation where there is doubt about an aspect of clinical diagnosis, prognosis, or management.
EBM is an approach to clinical problem-solving based on "systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions" REF .
Evidence based medicine: an approach to clinical problem-solving.
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BMJ
Medicine