The evidence-based medicine model of clinical practice: scientific teaching or belief-based preaching?

Authors

  • Cathy Charles PhD,

    Corresponding author
    1. Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada and Member, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
      Dr Cathy Charles, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, CRL – Rm. 205, Hamilton, ON L8N 3Z5, Canada. E-mail: charlesc@mcmaster.ca
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  • Amiram Gafni PhD,

    1. Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada and Member, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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  • Emily Freeman PhD

    1. Edith Kirchmann Postdoctoral Research Fellow in Psychosocial Oncology and Palliative Care, University Health Network, University of Toronto, Department of Psychiatry, Toronto, ON, Canada
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Dr Cathy Charles, Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St. West, CRL – Rm. 205, Hamilton, ON L8N 3Z5, Canada. E-mail: charlesc@mcmaster.ca

Abstract

Rationale  Evidence-based medicine (EBM) is commonly advocated as a ‘gold standard’ of clinical practice. A prominent definition of EBM is: the integration of best research evidence with clinical expertise and patient values. Over time, various versions of a conceptual model or framework for implementing EBM (i.e. how to practice EBM) have been developed.

Aims and objectives  This paper (i) traces the evolution of the different versions of the conceptual model; (ii) tries to make explicit the underlying goals, assumptions and logic of the various versions by exploring the definitions and meaning of the components identified in each model, and the methods suggested for integrating these into clinical practice; and (iii) offers an analytic critique of the various model iterations.

Methods  A literature review was undertaken to identify, summarize, and compare the content of articles and books discussing EBM as a conceptual model to guide physicians in clinical practice.

Results  Our findings suggest that the EBM model of clinical practice, as it has evolved over time, is largely belief-based, because it is lacking in empirical evidence and theoretical support. The model is not well developed and articulated in terms of defining model components, justifying their inclusion and suggesting ways to integrate these in clinical practice.

Conclusion  These findings are significant because without a model that clearly defines what constitutes an EBM approach to clinical practice we cannot (i) consistently teach clinicians how to do it and (ii) evaluate whether it is being done.

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