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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 |
