Education And Debate

Evidence based medicine: an approach to clinical problem-solving

BMJ 1995; 310 doi: http://dx.doi.org/10.1136/bmj.310.6987.1122 (Published 29 April 1995) Cite this as: BMJ 1995;310:1122
  1. William Rosenberg, clinical tutor in medicinea,
  2. Anna Donald, senior house officerb
  1. a Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford OX3 9DU
  2. b Public Health and Health Policy, Anglia and Oxford Regional Health Authority, Oxford OX3 7LF
  1. Correspondence to: Dr Rosenberg.

    Doctors within the NHS are confronting major changes at work. While we endeavour to improve the quality of health care, junior doctors' hours have been reduced and the emphasis on continuing medical education has increased. We are confronted by a growing body of information, much of it invalid or irrelevant to clinical practice. This article discusses evidence based medicine, a process of turning clinical problems into questions and then systematically locating, appraising, and using contemporaneous research findings as the basis for clinical decisions. The computerisation of bibliographies and the development of software that permits the rapid location of relevant evidence have made it easier for busy clinicians to make best use of the published literature. Critical appraisal can be used to determine the validity and applicability of the evidence, which is then used to inform clinical decisions. Evidence based medicine can be taught to, and practised by, clinicians at all levels of seniority and can be used to close the gulf between good clinical research and clinical practice. In addition it can help to promote self directed learning and teamwork and produce faster and better doctors.

    Doctors must cope with a rapidly changing body of relevant evidence and maximise the quality of medical care despite the reduction in junior doctors' working hours and scarce resources. We are deluged with information, and although much of it is either invalid or irrelevant to clinical practice, an increasing amount comes from powerful investigations such as randomised controlled trials. Yet we continue to base our clinical decisions on increasingly out of date primary training or the overinterpretation of experiences with individual patients,1 and even dramatically positive results from rigorous clinical studies remain largely unapplied.2 Doctors need new skills to track down the new types of strong and useful evidence, distinguish it from …

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