Comparing the old world (before evidence based practice) and the new world (with evidence based practice)
 

	Old world	New world
Source of knowledge	Expert opinion	Systematic analysis of the evidence
Nature of clinical skills	Semi-mystical	Open to systematic analysis
Position of research	Marginal	Central
Essential skills	Clinical	Clinical plus ability to appraise evidence
Analysis of research	Haphazard	Systematic
Importance of gathering new evidence on patients	Low	High
Type of research	Clinical (often descriptive) Pathophysiological Basic	Clinical but based on epidemiological principles Evaluative
Essential information sources	Experts Textbooks Selected journals	Electronic access to all research evidence  Cochrane Library
Importance of statisticians, epidemiologist, economists, etc	Low	High
Assumption that medical care is producing benefit	High	Low
Recognition that much of medical care may be ineffective or harmful	Low	High
Importance of keeping up to date, learning new skills	Lip service	Essential
Importance of access to research evidence	Low	High
Importance of systematic analysis of performance	Low	High
Organisational model	Hierarchical	Democratic, based in part on knowledge of evidence and ability to interpret it
Capacity of managers to get involved in the clinical process	Low	High
Nature of relationship to patients	Expert to pupil	Potentially much more equal