Not all clinicians need to appraise evidence from scratch but all need some skills

High quality health care implies practice that is consistent with the best evidence. An intuitively appealing way to achieve such evidence based practice is to train clinicians who can independently find, appraise, and apply the best evidence (whom we call evidence based practitioners). Indeed, we ourselves have advocated this approach.1 Now, however, we want to highlight the limitations of this strategy and suggest two complementary alternatives.

The skills needed to provide an evidence based solution to a clinical dilemma include defining the problem; constructing and conducting an efficient search to locate the best evidence; critically appraising the evidence; and considering that evidence, and its implications, in the context of patients' circumstances and values. Attaining these skills requires intensive study and frequent, time consuming, application.

After a decade of unsystematic observation of an internal medicine residency programme committed to systematic training of evidence based practitioners,1 we have concluded—consistent …