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