Evidence Based Practice
Step 1: Asking an Answerable Question and Identifying Keywords
The five steps in this tutorial are designed to walk you through the process of evidence-based practice. This initial version just provides a framework to help you think through your question, find the evidence, review it and apply it. Future versions will provide "help" through interactive responses and links to other resources in areas which are identified by your feedback. Once you are familiar with the process, you may use the tools without the whole tutorial process. Upon completion of the Evidence-Based Practice Tutorial you will receive 1 CME Credit. In addition, those who are participating in the accompanying research project can refer one search for the evidence to the librarians at the University of Washington Health Sciences Library for each tutorial completed. We suggest that you do one a month for one year to become facile with the process.
Some Background information...
EVIDENCE-BASED PRACTICE (EBP) is defined as…
integration of individual clinical expertise, best available systematically reviewed evidence from research and relevant population data with patient preferences at the time of clinical decision-making (Sackett DL et al. BMJ 1996; 312:71-72)
This is different than the theoretical concept of EVIDENCE-BASED MEDICINE which requires access to primary research literature, critical appraisal skills, extended time for synthesis and review. This process is suitable for guideline and policy development, not point of care decision-making.
The steps in EBP include
I – Asking an Answerable Question and Identifying Keywords
The first step in the Tutorial helps you refine your inquiry by taking the “question in your head” and using a process (PICO or the QUEST program) to convert it into a more standardized, “answerable question”. This process will facilitate your search by helping you to identify keywords specific to the patient population, intervention, comparison group and outcomes that are appropriate to your patient care inquiry.
The second step in the EBP process is to search for an evidence-based answer to your question using the keywords you have identified. There are now many sources of critically appraised information that can be accessed rapidly via the Internet. The link in this tutorial takes you to a site where most of these have been assembled in order of their efficiency and utility. As you find references, you must screen them for relevance to select only those that address your specific question as closely as possible.
Once you have selected the most relevant sources of evidence, you must evaluate their validity ( in terms of the likelihood of bias in the research or the review). In general, you are more likely to find high levels of validity in evidence-based summaries of topics (systematic reviews or meta-analyses) from sources known to use a well-defined rigorous appraisal process (like Cochrane, Clinical Evidence, JFP – Clinical Inquiries), next are evidence-based guidelines and critical appraisals of an article. You can determine validity informally by knowing the summarizing source to be rigorous or formally using a tool like the JAMA articles on assessing systematic reviews, etc.
After you have selected the sources which are relevant and valid, you will identify the conclusions of the study and compare them. If there are conflicting results, you must look at the evidence to find explanations for the differences and resolve them.
In the final step o EBP, you must decide whether the recommendations you have summarized from the available relevant and valid research apply to your patient. First, you must determine whether the patient’s studied are similar enough to your patient that you can extrapolate the recommendations. Second, you must communicate the research data to you patient and help them make an informed decision based on their needs and values.
Begin working on Step 1: Asking an Answerable Question and Identifying Keywords.
When you are finished with Step 1, click here to continue on with Step 2.