Evidence-Based Practice: An Introduction and Overview
Section snippets
Forms of EBM Practice
There are 2 types of EBM practice known as “top-down” and “bottom-up”4 (Table 1). Top-down EBM is carried out by experts and leaders in the field, who seek out the best evidence where it is lacking. These experts work for centralized resources, such as the Cochrane collaboration,5 government sponsored health technology assessments, such as the Agency for Healthcare Research and Quality (AHRQ),6 or working groups set up by professional bodies, such as the American College of Radiology (ACR)7 in
Foreground and Background Knowledge Gaps
To care for patients, healthcare workers need to have the right knowledge to better inform clinical decisions and actions.19, 20 Our need for knowledge can vary from the obvious (and straightforward to find) to the subtle and complex (and difficult to find). The information we need will be evidence derived from clinical research studies. In most situations, we will already have some information and will know that some information is missing, but we may not realize that other information is
Technical Knowledge and Professional Artistry
The author Donald Schon introduced the concept of “reflective practice” in his book in 1984 (Table 2).23 At the end of professional training, one has acquired enormous technical knowledge and a familiarity with routines and protocols. Conventional teaching indicates that this knowledge base is permanent, but the reality is that hereafter the knowledge that is not used every day will be rapidly lost (“use it or lose it”). Professional artistry regards knowledge as being problematic. With
Alternative Forms of Medical Practice
With conventional or eminence-based medical practice, senior physicians teach pathophysiology using didactic methods, and information from their experience and expertise.24 Friedland25 described the 4 assumptions of traditional medical teaching as follows:
- 1
The measure of authority is proportional to the weight of individual experience.
- 2
Understanding pathophysiology forms the foundation for clinical practice.
- 3
Conventional medical training and common sense are enough to enable a physician to
Why Is There Such an Interest in EBM?
Interest in EBM has increased exponentially since the coining of the term by Dr Guyatt in 1992,3 from 1 MEDLINE citation in 1992 to more than 31,000 in October 2008. Professional organizations and training programs for healthcare workers have progressed from introducing EBM through how to teach it as evidenced by the increase in courses, workshops, and seminars in EBM. There are 5 underlying reasons for the explosion in EBM.
First is the need to be updated on information about diagnosis,
Steps Involved in Bottom-Up EBP
The practice of bottom-up EBM involves 5 steps, which can be summarized as “Ask,” “Search,” “Appraise,” “Apply,” and “Evaluate” (Table 4).
The first step is to convert the need for information into an answerable question, which will be covered in the next article in this issue. Once the question has been asked, the second step is to track down the best evidence with which to answer the question. This will be covered in a later article in this issue. Once the evidence has been obtained, the third
Why Should Radiologists Learn EBP?
Core radiological knowledge that is taught in the curriculum for residents to prepare for formal examinations, and practical teaching at the view box, are essential skills. However, it is recognized that radiology trainees need to acquire the art of reading, interpreting, understanding, and applying the literature in clinical practice.45, 46, 47 These skills apply to more than clinical practice, with small-group EBP in radiology linked to promotion of research in residents48, 49, 50 and the
How Should EBP Be Taught to Radiologists?
With educational practice, there are 3 components: (1) curriculum, (2) instruction, and (3) assessment.58
The curriculum refers to material that we intend our students to learn and has formal and informal components. The formal curriculum includes the course syllabus, lecture material, and reading assignments. For example, information on the steps involved in bottom-up EBM or critical appraisal methodology would lend itself to learning within the formal curriculum. The informal curriculum
Pitfalls in Dissemination of Evidence-Based Review: Caveats and Cautions
There are pitfalls and cautions that need to be borne in mind with the dissemination of evidence-based review (EBR).63 First, the increased awareness of EBR has led to a proliferation in information resources. However, the term EBR has been applied to guidelines and consensus recommendations that lack the methodological rigor of the EBR process. Therefore, the reader must be able to assess whether the so-called EBR review is in fact based on a systematic review of the literature or if it is
Conclusion
Evidence-based radiology is defined as the integration of the best research evidence with clinical radiologists' expertise, the ALARA principles, and the referring clinicians and patients' values and expectations. There are 2 approaches to EBR, the “top-down” and “bottom-up,” which are not mutually exclusive and which complement each other. Evidence is needed to fill in “knowledge gaps” and the bottom-up approach comprises 5 steps, which will be described in the following articles. The practice
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