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University Library, University of Illinois at Urbana-Champaign

Evidence-Based Medicine (EBM)

EBM Timeline

EBM emerged in the 1990s as a strategy to improve patient care. EBM practice involves the use of the best available research evidence with patient values and clinical judgment for clinical decision making.  EBM focuses on diagnosis, treatment, etiology, prognosis, risk and harm.

  • 1991 - At McMaster Universitiy, Canada, Gordon Guyatt convenes the EBM Working Group.
  • 1991 - Users Guides to the Medical Literature are first published in JAMA and become seminal works for EBM practice.
  • 1992 - EBM Working Group publshes "Evidence-Based Medicine: a new approach to teaching the practice of medicine." JAMA. 1992 Nov 4;268(17):2420-5.PMID:1404801
  • 1996 - David Sacket et al publish "Evidence-Based Medicine: what it is and what it isn't". Clin Orthop Relat Res. 2007 Feb;455:3-5. PMID:17340682

EBM According to MeSH

EBM vs. EBP

Evidence-based Practice (EBP)

  • Aims to provide on the best care for patients or patient populations based on research evidence, expertise and external circumstances.
  • Focus is on Prevention and Health Promotion
  • Interventions strive to improve behavior, attitudes and knowledge

Evidence-based Medicine (EBM)

  • EBM begins and ends with an individual patient
  • Clinical issues are frequently concerned with Therapy, Diagnosis, Etiology, Prognosis
  • Interventions focus on therapeutics and diagnostics tests

Benefits of EBM

  • Potential to Improve patient care
  • Potential for reduction in medical errors
  • Can help control costs
  • Contributes to patient-centered care
  • Contributes to practitioner’s knowledge base
  • Provides “just in time” information at the point of need

EBM Criticisms & Caveats

  • Sometimes there is no reliable research evidence to guide decision making, and some conditions are rare enough that there is no way to do large studies
  • There are claims that EBM ignores key elements of clinical decision making
    • Education, Experience, Intuition
  • There are claims that EBM neglects to consider the patient
    • Type and severity of symptoms
    • Rate of progression of Illness
  • There are perceptions that EBM relies too heavily on RCTs as the gold standard for evidence