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Resource Corner

Evidence-Based Medicine: How to Practice and Teach EBM

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ACP J Club. 2001 Jan-Feb;134:A15. doi:10.7326/ACPJC-2001-134-1-A15



If you want to further enhance your ability to practice evidence-based medicine and weave it into your clinical teaching, rush out to buy the new edition of this popular handbook. Its international authors provide unique insights into and practical strategies for using the evidence-based-medicine approach in clinical problem solving during daily medical practice. This text is applicable to the needs of a wide range of learners, from medical students to clinician educators and practicing physicians.

It is written in a comfortable conversational tone, as in the 1st edition, and each chapter is peppered with helpful tables. Illustrative clinical examples appear throughout the book. 3 significant improvements from the 1st edition are a new organizational structure, a stronger section on teaching methods, and an accompanying CD.

The first few chapters address how to ask answerable clinical questions and specific search strategies to find the best available evidence. The closing chapter addresses self-evaluation, including what is known about the evaluation of evidence-based medicine. In between, the chapters are organized according to the tasks that clinicians face during clinical practice (e.g., diagnosis, prognosis, and therapeutics). The chapters use a format that consistently addresses distilled issues related to the assessment of validity, importance, and applicability of medical evidence. There are also 2 appendices: One covers confidence intervals and includes formulae, and the other is a practical glossary. Inside the back cover are colorful laminated pocket cards that can reinforce basic concepts when on the run.

In addition to the content that helps us to practice evidence-based medicine, the book sporadically addresses methods to help us teach in a more evidence-based fashion. Further, a new 35-page chapter focuses solely on this area. It discusses general notions about teaching evidence-based medicine and venue-specific strategies for inpatient and outpatient arenas; it even includes a discussion of the “top 7 teaching mistakes” that most of us have made. The chapter ends with an extensive table of teaching tips to use when facilitating small-group learning.

The mini-CD, in a pocket affixed to the front cover, is easy to use either from your CD drive or by copying onto your hard drive. The latter option is convenient if you store your computer's central processing unit on its side because properly seating the small CD is a bit of a challenge. Once open, the interface is somewhat clunky, but after making a few wrong turns, I was able to quickly learn how to maneuver within it. For example, when I first opened the page titled “CD Contents,” I saw only an electronic version of the same contents as in the printed book. I eventually found other extensive resources under the cryptic link “Discipline Contents” in the bottom corner of the page that were applicable to a wide range of clinicians, from pediatricians to nurses to surgeons. Each of 14 different discipline sections aspires to provide a contact person, an introduction to the use of explicit evidence in his or her field, annotated references, sample teaching scenarios, searches, completed appraisal worksheets, and examples of critically appraised topics.

Although this ambitious addition to the book is potentially quite useful for practitioners and teachers, the current development under each discipline is varied. Some sections contain 1 or more examples, as in “Child Health,”“Critical Care Medicine,” and “General Practice”; but no examples are provided in “Occupational Health,” and only 1 is included in “Complementary Medicine.” To address this limitation, the authors are developing a Web site that will complement the book by providing regularly updated material for visitors. The site is based at the newly established Centre for Evidence-Based Medicine at the University of Toronto (www.cebm.utoronto.ca/). When I went to their site, I found a well-established initiative, and a listing of mistakes found in the 2d-edition print version is already posted. I've bookmarked this useful site for regular future browsing.

Whether you use Evidence-Based Medicine for its individual chapters when you have a particular task or decide to devour it cover to cover, it will not only satisfy you but also leave you wishing they could have fit even more material into its practical pocket-sized cover. The authors convey a fun and irreverent enthusiasm for a subject that is simply infectious. It will become a well-worn addition to my library, and I will strongly encourage my learners to invest in a copy.

Mark C. Wilson, MD
Wake Forest University School of Medicine
Winston-Salem, North Carolina, USA

Ratings

Methods/Quality of Information: 5 of 5 stars

Clinical Usefulness: 4 of 5 stars

Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine: How to Practice and Teach EBM. 2d edition. Edinburgh: Churchill Livingstone; 2000.

Evidence-Based Medicine: How to Practice and Teach EBM can be purchased online at www.harcourt-international.com/catalogue for U.S. $34.95; a sample chapter can also be viewed on this site.