Evidence-Based Health Care

• Clinical Curiosity initiatives are for students to use research and learn to become researchers
• This aligns to develop lifelong learning, educating others, decision making with evidence, and research contributions
• Healthcare decisions must account for the best available research
• Quality of care should be equal to what loved ones expect

Evidence-Based Health Care (EBHC)

• EBHC integrates best research, expertise, values, and circumstances
• EBHC uses current best evidence to make decisions about individual patient care
• EBHC assesses validity and importance before applying evidence to daily clinical problems

Three principles of EBHC

• Intersect the best available research, patient values and preferences, and doctor's expertise

Addressing Uncertainty

• EBHC addresses uncertainty in healthcare by heavy reliance on research
• The COVID-19 pandemic exemplified the value of understanding a virus through research

Avoiding Harm and Waste

• Research determines working and harmful interventions to prevent wasted resources
• Understanding research methods helps evaluate findings and avoid poor conclusions

Continuous Improvement and Progress

• Medical knowledge is always evolving
• Research and investigation help to update and develop current practices
• Science builds cumulatively on existing knowledge

Informed Decision-Making

• Critical research evidence is needed, but on it's own is not sufficient
• Evidence-informed decision-making (EIDM) uses cost-effectiveness, patient values, ethics, and resources
• Research guides and informs decision-making

Developing Essential Skills

• Essential skills are to phrase questions, identify relevant research, appraise quality, and interpret findings
• The "Scholar" must use research by integrating evidence into practice and creating new knowledge

Rationale for Evidence-Based Health Care (EBHC)

• Provide the best care for patients
• Make decisions by taking research into account
• Aim to provide same care for anyone's family

Address Uncertainty in Health Care Decision-Making

• Healthcare is uncertain
• EBHC helps with uncertainty using research for guidance

Navigate the Information Explosion

• Medical information is massive
• EBHC filters, assesses, and applies recent findings amid constant "information explosion"

Prioritize Doing More Good Than Harm

• Healthcare relies on helping and not harming
• EBHC acheives this by identifying ineffective interventions and what could be harmful instead of relying on tradition, anecdotes, or unsupported claims
• EBHC ensures healthcare resources should not be "wasted" on ineffective interventions
• EBHC contributes to effective resource allocation

Acknowledge the Evolving Nature of Medical Knowledge

• The field of medicine is always evolving
• EBHC uses lifelong learning, constantly integrates new findings, and emphasizes that science is cumulative

Critically Evaluate Research

• Not all research is credible, so don't assume conclusions are always accurate
• EBHC critically appraises research methods and reliability in order to identify reliable information

Integrate Multiple Factors in Decision-Making

• EBHC integrates best research evidence, expertise, and patient variables
• Contextual factors like cost-effectiveness and ethics are also important

Sources of information that contribute to medical practices

• Some sources have reliable information, while others should be interpreted with care
• Research evidence tends to be the most reliable

Beliefs and Tradition

• Medical practices were influenced by established beliefs
• Relies entirely on tradition to evaluate practices against research findings

Hearsay & Mass Media

• Sources disseminate health claims rapidly
• These are not reliable since they are often not based on rigorous scientific practices
• Healthcare professionals must interpret this information carefully

Expert Opinion

• Valuable including textbook information and expertise of experienced clinicians
• Can be valuable, however not always the must up-to-date or rigorously tested

Theory

• Theoretical frameworks generate hypothesis about how treatments can work
• Research is needed to validate theoretical assumptions

Research Evidence

• Is the cornerstone to EBHC

Types of research evidence

• Opinions, editorials and anecdotal viewpoints spark investigation, though do not have strong evidence
• Case reports identify rare conditions or adverse effects
• Case series group patients with similar conditions
• Studies on diagnosis, prevalence, incidence, prognosis, aetiology, and risk factors help determine factors that influence results
• Treatment and prevention studies determine effectiveness and safety of treatments
• Systematic reviews involve comprehensive searches that inform clinical questions followed by appraisal and synthesis, providing a high level of evidence

Questions and the PICO(TS) or PECO(TS) framework

• There are broad background questions, or detailed foreground questions
• Broad questions help build general knowledge and can be found using textbooks
• Detailed questions involve an intervention and outcome, answered using studies
• PICO(TS) (Patient/Population, Intervention, Comparison, Outcome, and Time and Setting)
• PECO(TS) (Population, Exposure, Comparison, Outcome, and Time and Setting)
• A well-built question is concise and aligns with specific questions with specific research guidelines