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Evidence-Based Medicine
  1. Mark C Wilson, MD, MPH
  1. Wake Forest University School of Medicine,Winston-Salem,North Carolina, USA

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    If you want to enhance your skills further to practice evidence-based medicine and weave it into your clinical teaching, rush out to buy the new edition of this popular handbook. Its international authors provide unique insights and practical strategies to use this approach in clinical problem solving during daily medical practice. This text is applicable to the needs of a wide range of learners, from medical students to clinician educators and practicing physicians.

    Sackett DL, Strauss SE, Richardson WS, et al. Evidence-Based medicine:how to practice and teach EBM. Second edition. Edinburgh:Churchill Livingstone, 2000.

    Consistent with the first edition, it is still written in a comfortable conversational tone, and each chapter is peppered with helpful tables. Illustrative clinical examples appear throughout the book. 3 significant new improvements are a new organisational structure, a stronger section on teaching methods, and an accompanying CD.

    The first few chapters address asking answerable clinical questions and specific search strategies to find the best available evidence. The closing chapter addresses self evaluation, including what is known about the evaluation of evidence-based medicine. In between, the chapters are organised according to the tasks that clinicians face during clinical practice (eg, diagnosis, prognosis, and treatment). The chapters use a format that consistently addresses distilled issues related to the assessment of validity, importance, and applicability of medical evidence. There are also 2 appendices. One covers confidence intervals and includes formulas and the other is a practical glossary. Inside the back cover are colourful laminated pocket cards that can reinforce basic concepts when on the run.

    Beyond the content issues to help us practice evidence-based medicine, methods to help us to teach in a more evidence-based fashion are addressed sporadically throughout the text. Furthermore, a new 35 page chapter focuses solely on this area. It addresses general notions about teaching evidence-based medicine, venue specific strategies for inpatient and outpatient arenas, and even includes a discussion of the “Top 7 Teaching Mistakes” that most of us have made. Finally, the chapter ends with an extensive table of teaching tips to use when facilitating small group learning.

    The mini CD resides in a pocket affixed to the front cover. It is easy to use either from your CD drive or by copying onto your hard drive. The latter option is convenient if you store your CPU on its side since properly seating the small CD is a bit of a challenge. Once open, the interface is somewhat clunky, but after making a few “wrong turns,” I was able to quickly learn how to manoeuver within it. For example, when I first opened the page entitled “CD Contents,” I saw only an electronic version of the same contents as in the printed book. Eventually I found other extensive resources under the cryptic link labelled “Discipline Contents” in the bottom corner of that page. Here are rich resources applicable to a wide range of clinicians from paediatricians to nurses to surgeons. Each of 14 different discipline sections aspires to provide a contact person, an introduction to the use of explicit evidence in their field, annotated references, sample teaching scenarios, searches, completed appraisal worksheets, and examples of critically appraised topics.

    Although this ambitious addition to the book is potentially quite useful for practitioners and teachers, the current development under each discipline is variable. Some sections contain multiple worked examples, as in “Child Health,” “Critical Care Medicine,” and “General Practice,” but no examples are provided in “Occupational Health” and only 1 is included in “Complementary Medicine.” To address this limitation, the authors are developing a web site to complement the book by providing regularly updated material for visitors. The site is based at the newly established Centre for Evidence-Based Medicine at the University of Toronto (www.library.utoronto.ca/medicine/ebm/). When I surfed to their site, I found a well established initiative, and already posted is a listing of mistakes found in the second edition print version. I've bookmarked this useful site for future browsing on a regular basis.

    The second edition of this handbook is a substantial revision of its predecessor and will aid any healthcare provider who aspires to improve his or her skills in evidence-based practice. Be aware that although this edition acknowledges the range of evidence-based resources now available for clinical care, the emphasis of the book is still weighted toward developing critical appraisal skills to better use original literature from Medline. Whether you use the book for its individual chapters when you have a particular task, or decide to devour it cover to cover, it will both satisfy and leave you wishing they could have fit even more material into this practical pocket sized book. The authors convey a fun and irreverent enthusiasm for a subject that is simply infectious. It will become a well worn addition to my library and I will strongly encourage my learners to invest in a copy.

    Ratings for this resource

    Methods/Quality of information: ★★★★★

    Clinical usefulness: ★★★★☆

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