Harnessing experience: exploring the gap between evidence-based medicine and clinical practice
Article first published online: 31 OCT 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 14, Issue 5, pages 707–713, October 2008
How to Cite
Hay, M. C., Weisner, T. S., Subramanian, S., Duan, N., Niedzinski, E. J. and Kravitz, R. L. (2008), Harnessing experience: exploring the gap between evidence-based medicine and clinical practice. Journal of Evaluation in Clinical Practice, 14: 707–713. doi: 10.1111/j.1365-2753.2008.01009.x
- Issue published online: 31 OCT 2008
- Article first published online: 31 OCT 2008
- Accepted for publication: 10 March 2008
- clinical experience;
- decision making;
- Evidence-based Medicine;
- Evidence Farming;
- medical epistemology
Rationale, aims and objectives There is mounting evidence of a gap between Evidence-based Medicine (EBM) and physician clinical practice, in part because EBM is averaged global evidence gathered from exogenous populations which may not be relevant to local circumstances. Local endogenous evidence, collected in particular and ‘real world’ patient populations may be more relevant, convincing and timely for clinical practice. Evidence Farming (EF) is a concept to provide such local evidence through the systematic collection of clinical experience to guide more effective practice.
Methods We report on the findings of a pilot study of 29 individual and three focus group (n = 10) interviews exploring physicians' evaluations how they use multiple sources of information in clinical decision making and their thoughts on EF.
Results Physicians recognize a gap in translating EBM to practice. Physicians reported that when making clinical decisions, they more often rely on clinical experience, the opinions of colleagues and EBM summarizing electronic clinical resources rather than refer directly to EBM literature. Confidence in making decisions based on clinical experience increases over time, yet few physicians reported having systems for tracking their clinical experience in designing treatment plans and patient outcomes. Most physicians saw EF as a promising way to track experience, thereby making scientific evidence more relevant to their own clinical practices.
Conclusion Clinical experience is relatively neglected by the EBM movement, but if that experience were systematically gathered through an approach such as EF, it would meet a need left unfulfilled by EBM.