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Evidence-based decision making—the six step approach
  1. Franz Porzsolt, MD, PhD1,2,
  2. Andrea Ohletz, MD2,
  3. Anke Thim2,
  4. David Gardner, MD3,
  5. Helmuth Ruatti, MD4,
  6. Horand Meier, MD4,
  7. Nicole Schlotz-Gorton5,
  8. Laura Schrott, PhD6
  1. 1University Hospital Ulm
 Ulm, Germany
 Ludwig Maximilians University
 Munich, Germany
  2. 2Ludwig Maximilians University
 Munich, Germany
  3. 3Dalhousie University
 Halifax, Nova Scotia, Canada
  4. 4Bressanone Hospital 
 Bressanone, Alto Adige, Italy
  5. 5University Hospital Ulm
 Ulm, Germany
  6. 6Bureau for Education of Health-Care Personnel
 Autonomous Province of Bolzano, Alto Adige, Italy

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    The basic concept of evidence-based medicine proposes to make health related decisions based on a synthesis of internal and external evidence. Internal evidence is composed of knowledge acquired through formal education and training, general experience accumulated from daily practice, and specific experience gained from an individual clinician-patient relationship. External evidence is accessible information from research. It is the explicit use of valid external evidence (eg, randomised controlled trials) combined with the prevailing internal evidence that defines a clinical decision as “evidence-based.” To realise this concept in day to day clinical practice, the Evidence-Based Medicine Working Group proposed a 5 step strategy,1 corresponding to step 1 and steps 3 to 6 shown in the left hand column of the table.

    In teaching this 5 step approach, we encountered several difficulties. We noticed a growing hesitance to accept this strategy as students advanced in their medical training. In the presence of well established methods of treatment or …

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