Evidence-Based Medicine: Definition & Components

Instructor: Candice Jones

Candice has been a registered nurse for 11 years with current experience in college-level instruction and has a MSN in Nursing Education.

What is evidence-based medicine (EBM) and how does it improve patient outcomes? In this lesson, we will define EBM according to Sackett, including its three major components: expertise, research, and patient values.

What is Evidence-Based Medicine?

If you've had a pulse on the healthcare industry over the past few decades, then you have most likely heard or read about the term evidence-based medicine. According to Dr. David Sackett, evidence-based medicine, or EBM, is the ''conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.'' The hallmark of EBM is providing patient-centered care while combining a clinician's education and experience along with knowledge derived from systematic research from external clinical sources.

Let's imagine we are baking some cookies. The quality of the ingredients in the cookies and how well the cookies are made will ultimately determine how the cookies will taste. Similar to baking cookies, the concept of EBM is only as good as the quality of its three ingredients, or components: expertise, research, and patient values. Add a dash of expertise, a smidge of research, and some patient values and presto! You have evidence-based medicine!

Expertise

When patients seek medical care, they are naturally inclined to want to seek the experts in their chosen medical field. Expertise is defined as being knowledgeable and skillful in a certain area of practice. If patients feel they are being cared for by an expert, then they will feel a sense of safety and security. At the end of the day, EBM strives to provide safety in numbers for patients with similar health conditions or diseases.

A certified nurse-midwife, or CNM, has expertise in managing normal, low-risk pregnancies and birth as determined by professional organizational standards, such as from the American College of Nurse-Midwives. A CNM might consult another CNM or OB-GYN as any clinician does when necessary. The CNM has expertise up to a certain level of care. Researchers have found if a woman is determined to have a high-risk pregnancy, then the referral and expertise of an obstetrician-gynecologist, or OB-GYN, is indicated. Thus, clearly defined roles for CNMs and OB-GYNs have been created through evidence-based medicine.

Research

Clinical research, primarily from clinical trials, is what puts the evidence in evidence-based. The gold standard of scientific research has always been the randomized double-blind placebo-controlled study, or RDBPC. In RDBPC studies, both the researchers and the participants do not know who is receiving the treatment and who is receiving the placebo. Variables and biases are easier to control within this setting, which systematically provides a solid foundation upon which to guide medical treatments.

Western medicine is always on the cutting edge. Think of all the countless new medications, updated treatment protocols, stronger diagnostic tests, and more accurate prognostic markers being improved upon or discovered at an alarming speed. Medical practice often has a difficult time keeping up with all of the clinical research being generated on a regular basis!

A key point to consider: does newer and faster always mean better? At what point are clinicians utilizing too much research to guide practice? When does EBM not fit the mold for a specific patient?

For example, in a small randomized study, patients with influenza-like symptoms were given elderberry syrup four times a day for five days. These patients reported improved symptoms four days sooner and needed to use fewer rescue medications than the placebo group. While a study group larger than 60 is needed to determine if this preliminary research can truly become evidence-based medicine, it offers a safer alternative than most medications that suppress rather than support the body's natural immune response. Therefore, EBM is only as safe and effective as how quickly the research is being generated and then put into clinical practice. Think of all of the great treatments that are just around the corner or are already being proven that we do not know about yet!

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