1. The Problems: To keep up to date in Internal Medicine, an internist need to read at least 17 articles a day, 365 days a year To keep up to date in Internal Medicine, an internist need to read at least 17 articles a day, 365 days a year

2. Our textbooks are out-of-date Fail to recommend Rx up to ten years after it’s been shown to be efficacious. Fail to recommend Rx up to ten years after it’s been shown to be efficacious. Continue to recommend therapy up to ten years after it’s been shown to be useless. Continue to recommend therapy up to ten years after it’s been shown to be useless.

3. The inevitable consequence: on average, the clinically-important knowledge of physicians deteriorates rapidly after we complete our training.

4. The Slippery Slope 4 years since graduation r = -0.54 p<0.001............... knowledge of current best care

5. What ’ s the number needed to read?

6. Finding a needle in a haystack! The amount of information available vs. The relevant information Limited time

7. . how an evidence-based approach to practice, teaching, and research addresses these limitations of medical practice?

8. What evidence-based medicine is: …the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patient Sackett 1997 8

9. What evidence-based medicine is: The practice of EBM is the integration of individual clinical expertise with the best available external clinical evidence from systematic research. and patient’s values and expectations 9

10. 10 Clinical Expertise Research Evidence Patient Preferences

16. Five steps of EBM Practice 1Translation to an answerable question 2Efficient searching of the best evidence 3Critical appraisal of the evidence for its validity and clinical applicability 4Integration of that critical appraisal with clinical expertise and the patient’s unique biology and beliefs 5Evaluation of one’s performance. 16

18. EBM – removes stress of uncertainty

19. Part 1 - Principles of EBM

20. EBM - Background A Canadian connection! – The term "evidence based medicine" was coined at McMaster University’s Medical School in the 1980's to label a clinical learning strategy people at this school had been developing for over a decade. (BMJ 1995. 310:1122; MeSH, NLM, 2004) – The term EBM now encompasses: A philosophy A clinical strategy An application