Evidence-Based Medicine: Teaching Materials

Evidence–Based Medicine is the integration of best research evidence with clinical expertise and patient values. [Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2d ed. Edinburgh: Churchill Livingstone, 2000.]

• Overview
• Asking the Clinical Question
• Finding the Evidence
• Critical Appraisal Worksheets
• Appraising the Evidence: Therapy
• Appraising the Evidence: Diagnosis
• Appraising the Evidence: Systematic Reviews/Guidelines
• Applying the Evidence to the Patient

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Overview

• Evidence-based Answers to Clinical Questions for Busy Clinicians - from the Centre for Clinical Effectiveness (CCE), Monash Medical Centre, Australia
• The Evidence Cycle - from the Duke Program on Teaching Evidence-Based Practice
• Glossary of EBCP Terms
  
  

Asking the Clinical Question

• The Clinical Question Worksheet- (PDF or WORD)
• Focusing Clinical Questions - from the Oxford Centre for Evidence-Based Medicine
• Study Design - from the Oxford Centre for Evidence-Based Medicine
• Types of Studies - from the SUNY Downstate EBM Tutorial
• Types of Studies - from Yale University
• Understanding Research Study Designs - from the University of Minnesota Libraries, Bio-Medical Library

Finding the Evidence

• Evidence-Based Medicine Resources (resource pyramid and descriptions) - from the Dartmouth Biomedical Libraries
• Finding Evidence-Based Answers to Clinical Questions - Quickly and Effectively - from the Dartmouth Biomedical Libraries
• Useful MeSH for Evidence-Based Medicine - from the Hirsh Health Sciences Library, Tufts University

Critical Appraisal Worksheets - from the Dartmouth Biomedical Libraries

Appraising the Evidence: Therapy

Methodology (Validity) 

• Intention To Treat Principle - An article from CMAJ (November 13, 2001;165(10))
• Intention-to-treat concept: a review - (Gupta, S. Perspect Clin Res. 2011 Jul-Sep; 2(3): 109–112.)
• Intention to treat analysis, compliance, drop-outs and how to deal with missing data in clinical research - Review article from Physical Therapy Reviews

Interpreting Results (RRR, ARR and NNT) 

• Tips for learners of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. CMAJ. 2004 Aug 17;171(4):353-8. PMID: 15313996
• Tips for teachers of evidence-based medicine: 1. Relative risk reduction, absolute risk reduction and number needed to treat. CMAJ. 2004 Aug 17;171(4):online only
• CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials.
• Know your chances: Understanding health statistics - Woloshin, S., Schwartz, L. M., & Welch, H. G., Berkeley: University of California Press (2008). Book written for health consumers in easy to understand language about understanding health statistics.
• Effect Size Resources - An introduction, guide, and calculator from the Curriculum, Evaluation and Management Centre of Durham University, Durham, England.
• Do Cholesterol Drugs Do Any Good? - cover story from Business Week, Jan. 17, 2008 (good description of NNT, et.al., in the context of Lipitor research)
• NNT/NNH Calculator - from Alan Schwartz at the University of Illinois, Chicago.
• Visual Rx - Numbers Need to Treat - from Dr. Chris Cates' EBM Website (click on links under "Visual Rx" on left side of screen)
• Stating the Meaning of Effect Size Measures in Plain English - from the Duke Program on Teaching Evidence-Based Practice

Appraising the Evidence: Diagnosis

• Screening and Diagnostic Tests - from eMedicine
• Nomogram (pdf)
• Evidence-based Medicine: Answering questions of diagnosis - Clin Med Res 2004 Feb;2(1):63-9. PMID: 15931337
• An introduction to critical appraisal of articles of diagnosis - J Am Osteopath Assoc 2007 Aug;107(8):304-9. PMID: 17785687
• Websites for calculating sensitivity/specificity:
• Diagnostic Test Calculator - from Alan Schwartz at the University of Illinois, Chicago.
• CEBM Stats Calculator - from the Centre for Evidence-Based Medicine, University of Toronto

Appraising the Evidence: Systematic Reviews/Guidelines

• Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007 Feb 15;7:10. PMID: 17302989
• Interpreting meta-analysis in systematic reviews - Evid Based Med. 2008 Jun;13(3):67-9. PMID: 18515615
• Understanding systematic reviews: the meta-analysis graph (also called 'forest plot') - Intern Emerg Med. 2007 Jun;2(2):140-2. PMID: 17634820
• The AGREE Instrument for Appraising Practice Guideline

Applying the Evidence to the Patient

• Applying the Evidence: Worksheet ( PDF or WORD ) - from the Dartmouth Biomedical Libraries
• Shared Decision Making resources:
  • Dartmouth-Hitchcock Medical Center's Center for Shared Decision-Making (Click on Patient Resources on left side of screen)
  • Ottawa Personal Decision Guide
  • MedlinePlus - Authoritative information resources for patients/consumers from the National Library of Medicine