MCEM Part A Study Guide/Evidence Based Medicine

Definition of Evidence Based Medicine "Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research." ASSESS the patient: clinical problem or question arises from the care of the patient ASK the question: Construct a well built clinical question derived from the case (PICO) ACQUIRE the evidence: Select the appropriate resource(s) and conduct a search (eg. Cochrane, PUBMED) APPRAISE the evidence: Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) APPLY it to the patient: integrate the evidence with clinical expertise, patient preferences and apply it to practice Application of Statistics in Scientific Medical Practice Incidence Prevalence Relative Risk Reduction Absolute Risk Reduction Numbers Needed to Treat 2x2 Table: Sensitivity: Probability of a positive test result given the patient has the condition. A high sensitivity indicates relatively few false negatives and is useful for ruling out disease. (SnOut) Specificity: Probability of a negative test result given the patient does not have the condition. A high sensitivity indicates relatively few false positives and is useful for ruling in disease.(SpIn) Positive Predictive Value Negative Predictive Value Principles of Critical Appraisal Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context. Advantages and Disadvantages of Different Study Methodologies Randomized Controlled Clinical Trials Case-Control Cohort Clinical Audit Its pretty much impossible not to mention the role of clinical audit in evidence based practice External Links Bromley MCEM Statistics Lectures