Evidence-based Medicine (EBM) represents a paradigm shift in the ongoing evolution of the practice of medicine. This paradigm emphasizes the use of, when possible, systematic, reproducible, and unbiased observations recorded in the medical literature to increase one's confidence in the true prognosis, efficacy of therapy, and utility of diagnostic tests as they apply to questions about one's patients. It de-empahsizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making. It does not de-value the importance of intuition, clinical experience, and sound pathophysiologic understanding in the practice of medicine -- in fact, these are requirements of traditional teaching that need to be preserved -- but rather stresses taking it one step further in the critical examination of evidence from clinical research and applying the results to patient care.
To practice medicine in an evidence-based fashion, the clinician requires new skills, which include:
The principles of EBM allow the physician to (among others) make more accurate estimates of prognosis about a given disease, use therapeutic interventions more wisely, make sounder judgements about which diagnostic test to use given a certain clinical scenario, and to ultimately practice more cost-effective medicine.
It is important to note that EBM represents a paradigm shift, and is not meant to replace clinical experience and the development of clinical instincts, which are crucial parts of being a competent physician. Likewise, understanding of basic pathophysiologic mechanisms of disease is an important and integral part of medical training -- but is not enough.
Evidence-based Medicine Working Group. Evidence-based Medicine: A New Approach to Teach the Practice of Medicine. JAMA 1992;268(17):2420-2425.
Guyatt GH. Evidence-based Medicine. Ann Int Med. 1991;114(ACP Journal Club, suppl 2):A-16.