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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Evidence-based medicine | 6/6 | https://en.wikipedia.org/wiki/Evidence-based_medicine | reference | science, encyclopedia | 2026-05-05T09:56:04.124595+00:00 | kb-cron |
Research produced by EBM, such as from randomized controlled trials (RCTs), may not be relevant for all treatment situations. Research tends to focus on specific populations, but individual persons can vary substantially from population norms. Because certain population segments have been historically under-researched (due to reasons such as race, gender, age, and co-morbid diseases), evidence from RCTs may not be generalizable to those populations. Thus, EBM applies to groups of people, but this should not preclude clinicians from using their personal experience in deciding how to treat each patient. One author advises that "the knowledge gained from clinical research does not directly answer the primary clinical question of what is best for the patient at hand" and suggests that evidence-based medicine should not discount the value of clinical experience. Another author stated that "the practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." Use of evidence-based guidelines often fits poorly for complex, multimorbid patients. This is because the guidelines are usually based on clinical studies focused on single diseases. In reality, the recommended treatments in such circumstances may interact unfavorably with each other and often lead to polypharmacy. The theoretical ideal of EBM (that every narrow clinical question, of which hundreds of thousands can exist, would be answered by meta-analysis and systematic reviews of multiple RCTs) faces the limitation that research (especially the RCTs themselves) is expensive; thus, in reality, for the foreseeable future, the demand for EBM will always be much higher than the supply, and the best humanity can do is to triage the application of scarce resources. Research can be influenced by biases such as political or belief bias, publication bias and conflict of interest in academic publishing. For example, studies with conflicts due to industry funding are more likely to favor their product. It has been argued that contemporary evidence based medicine is an illusion, since evidence based medicine has been corrupted by corporate interests, failed regulation, and commercialisation of academia. Systematic Reviews methodologies are capable of bias and abuse in respect of (i) choice of inclusion criteria (ii) choice of outcome measures, comparisons and analyses (iii) the subjectivity inevitable in Risk of Bias assessments, even when codified procedures and criteria are observed. An example of all these problems can be seen in a Cochrane Review. A lag exists between when the RCT is conducted and when its results are published. A lag exists between when results are published and when they are properly applied. Hypocognition (the absence of a simple, consolidated mental framework into which new information can be placed) can hinder the application of EBM. Values: while patient values are considered in the original definition of EBM, the importance of values is not commonly emphasized in EBM training, a potential problem under current study. A 2018 study, "Why all randomised controlled trials produce biased results", assessed the 10 most cited RCTs and argued that trials face a wide range of biases and constraints, from trials only being able to study a small set of questions amenable to randomisation and generally only being able to assess the average treatment effect of a sample, to limitations in extrapolating results to another context, among many others outlined in the study.
== Application of evidence in clinical settings ==
Despite the emphasis on evidence-based medicine, unsafe or ineffective medical practices may occur. Contributing factors include clinicians not keeping up with or acting on current evidence, the rapid pace of scientific change, financial incentives, and patient demand for tests or treatments. Even when the evidence unequivocally shows that a treatment is either not safe or ineffective, it may take many years for other treatments to be adopted. Several factors may contribute to lack of uptake or implementation of evidence-based recommendations. These include lack of awareness at the individual clinician or patient (micro) level, lack of institutional support at the organisation level (meso) level or higher at the policy (macro) level. In other cases, significant change can require a generation of physicians to be replaced by physicians who were trained with more recent evidence. Revision of clinical guidelines to include an implementation plan may facilitate uptake of new procedures, including analysis of the context, identifying barriers and facilitators, and designing strategies to address them.
== Education == Training in evidence based medicine is offered across the continuum of medical education. Educational competencies have been created for the education of health care professionals. The Berlin questionnaire and the Fresno Test are validated instruments for assessing the effectiveness of education in evidence-based medicine. These questionnaires have been used in diverse settings. A Campbell systematic review that included 24 trials examined the effectiveness of e-learning in improving evidence-based health care knowledge and practice. It was found that e-learning, compared to no learning, improves evidence-based health care knowledge and skills but not attitudes and behaviour. No difference in outcomes is present when comparing e-learning with face-to-face learning. Combining e-learning and face-to-face learning (blended learning) has a positive impact on evidence-based knowledge, skills, attitude and behavior. As a form of e-learning, some medical school students engage in editing Wikipedia to increase their EBM skills, and some students construct EBM materials to develop their skills in communicating medical knowledge.
== See also ==
== References ==
== Bibliography ==
== External links ==
Evidence-Based Medicine – An Oral History, JAMA and the BMJ, 2014. Centre for Evidence-based Medicine at the University of Oxford.