Evidence-Based Medicine

Medicine is an ever-changing science. Advent of advanced technologies both in practice and research is making thinks possible which were previously not thought of.

The avenues of research has opened new arenas of knowledge in the practice of medicine where conventional knowledge from practice experiences are continuously being questioned.

Quite as expected every question is being attempted to be answered through research, and now evidence from research findings are guiding practice, and now the competence standards of practice universally accept the need for evidence-based medicine as the practice standards for all healthcare professionals (Ellis et al., 1995).

It is now recognised that individual patient’s care decisions must be based on current best evidence from research. In the clinical settings, therefore, individual clinical expertise is no longer alone the gold standard, rather every practice steps must be questioned and the answers about the right approach to decisions must be guided by external clinical evidence from research literature available through a systemic search.

While talking about systemic search, it needs access to vast literature databases, but without a well-formed focus question, there is a high propensity that search could be unsystematic and unyielding.

Therefore a focus questions based on clinical setting needs to be formed based on the issue, which can have different elements. These elements must corroborate to the basic clinical questions, and key concepts and words can be generated out of it.

There are several databases and libraries, where keyword based systematic searches would generate the most relevant literature, from which evidence can be sought. Seeking the evidence is also based on the right frame of questions, which can narrow down the literature right to the point where evidence is sought.

The investigator’s clinical expertise can guide the question to be framed, and hence with best clinical expertise and insight, the best issue based question can be designed. With the best questions, best search is possible, and therefore best answers and evidences (Sackett et al., 1996).

Example of EBM question in SICO format

S: For a multispecialty tertiary care healthcare organization in the intervention cardiology

I: Nurse delivered lifestyle risk factor modification interventions

C: Physician delivered lifestyle modification advices

O: To accomplish the best possible adherence

Complete Question:

For a multispecialty tertiary care healthcare organization in the intervention cardiology unit, will a nurse-delivered lifestyle risk factor modification intervention accomplish better results than a physician-delivered lifestyle modification advice?


Ellis, J., Mulligan, I., Rowe, J., and Sackett, DL., (1995). Inpatient general medicine is evidence based. Lancet;346:407-10

Sackett, DL., Rosenberg, WMC., Gray, JAM., Haynes, RB., Richardson, WS., (1996). Evidence based medicine: what it is and what it isn’t. BMJ; 312:71-72