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The most commonly used definition for EBM is that "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." provided by David Sackett et al in the 1996 article, " Evidence-Based Medicine: What it is and what it isn't" for BMJ.


5 "A's" of the EBP Decision Making Cycle

ASK the answerable clinical question.

ACQUIRE the most relevant and best evidence to answer the question.

APPRAISE the evidence critically for validity, relevance, and applicability.

APPLY the evidence, along with critical expertise and the patient's preferences and values.

ASSESS the effectiveness and efficiency of the application of evidence and assess one's ability to ask, acquire, appraise, and apply in order to improve one's ability to conduct EBP.

Melnyk, B. M., & Fineout-Overholt E. (2015). Making the case for evidence-based practice. In: B. M. Melnyk & E. Fineout-Overholt (Eds.), Evidence-based practice in nursing & healthcare: A guide to best practice (3rd ed., pp. 3-23). Wolters Kluwer. (UH Manoa Hamilton RT42 .M44 2015)

Straus, S. E., Glasziou, P., Richardson, W. S., Haynes, R. B., Pattani, R., & Veroniki, A. A. (2019). Evidence-based medicine: How to practice and teach EBM (5th ed.). Elsevier. (UH Manoa Hamilton E-book)


What is the P.I.C.O. Model?

Defining a clinical question in terms of the specific patient problem aids the searcher in finding clinically relevant evidence in the literature. 

Essentially, PICO is a focused search strategy.

P-I-C-O Model for Clinical Questions

 P   Patient, Population, or Problem   How would I describe a group of patients similar to  mine? 
I  Intervention, Prognostic Factor, or  Exposure   Which main intervention, prognostic factor,
 or exposure am I considering?
C  Comparison or Intervention (if  appropriate)   What is the main alternative to compare 
 with the intervention?
O   Outcome you would like to   measure or  achieve  What can I hope to accomplish, measure, 
 improve, or affect?
T  Time Interval  What is the time interval to achieve desired outcomes?
   What type of question are you  asking?  Diagnosis, Etiology/Harm, Therapy, Prognosis,
   Type of study you want to find  What would be the best study design/methodology?

Table based on: Evidence Based Medicine: PICO. UIC Library.