Editing Evidence-based medicine (section)

=== Medical education ===
The term 'evidence-based medicine' was introduced slightly later, in the context of medical education. In the autumn of 1990, [[Gordon Guyatt]] used it in an unpublished description of a program at [[McMaster University]] for prospective or new medical students.<ref name="howick">{{cite book | vauthors = Howick JH |title=The Philosophy of Evidence-based Medicine |publisher=Wiley |page=15 |isbn=978-1-4443-4266-6 |date=23 February 2011}}</ref> Guyatt and others first published the term two years later (1992) to describe a new approach to teaching the practice of medicine.<ref name="Guyatt" />

In 1996, David Sackett and colleagues clarified the definition of this tributary of evidence-based medicine as "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research."<ref name="sackett2">{{cite journal | vauthors = Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS | title = Evidence based medicine: what it is and what it isn't | journal = BMJ | volume = 312 | issue = 7023 | pages = 71–72 | date = January 1996 | pmid = 8555924 | pmc = 2349778 | doi = 10.1136/bmj.312.7023.71 }}</ref> This branch of evidence-based medicine aims to make individual decision making more structured and objective by better reflecting the evidence from research.<ref name="katz">{{cite book | vauthors = Katz DL |title=Clinical Epidemiology & Evidence-Based Medicine: Fundamental Principles of Clinical Reasoning & Research|url=https://archive.org/details/clinicalepidemio0000katz |url-access=registration |year=2001|publisher=Sage|isbn=978-0-7619-1939-1}}</ref><ref name="grobbee">{{cite book | vauthors = Grobbee DE, Hoes AW | title=Clinical Epidemiology: Principles, Methods, and Applications for Clinical Research|year=2009|publisher=Jones & Bartlett Learning| isbn=978-0-7637-5315-3}}</ref> Population-based data are applied to the care of an individual patient,<ref name="doi">{{cite book| vauthors = Doi SA |title=Understanding Evidence in Health Care: Using Clinical Epidemiology|year=2012|publisher=Palgrave Macmillan|location=South Yarra, VIC, Australia|isbn=978-1-4202-5669-7}}</ref> while respecting the fact that practitioners have clinical expertise reflected in effective and efficient diagnosis and thoughtful identification and compassionate use of individual patients' predicaments, rights, and preferences.<ref name=sackett2 />

Between 1993 and 2000, the Evidence-Based Medicine Working Group at McMaster University published the methods to a broad physician audience in a series of 25 "Users' Guides to the Medical Literature" in ''JAMA''. In 1995 Rosenberg and Donald defined individual-level, evidence-based medicine as "the process of finding, appraising, and using contemporaneous research findings as the basis for medical decisions."<ref name="rosenberg2">{{cite journal | vauthors = Rosenberg W, Donald A | title = Evidence based medicine: an approach to clinical problem-solving | journal = BMJ | volume = 310 | issue = 6987 | pages = 1122–1126 | date = April 1995 | pmid = 7742682 | pmc = 2549505 | doi = 10.1136/bmj.310.6987.1122 }}</ref> In 2010, [[Trisha Greenhalgh|Greenhalgh]] used a definition that emphasized quantitative methods: "the use of mathematical estimates of the risk of benefit and harm, derived from high-quality research on population samples, to inform clinical decision-making in the diagnosis, investigation or management of individual patients."<ref name="greenhalgh1">{{cite book| vauthors = Greenhalgh T |author-link=Trisha Greenhalgh|date=2010|title=How to Read a Paper: The Basics of Evidence-Based Medicine | edition = 4th |url=https://archive.org/details/howtoreadpaperba00tgre |url-access=limited |publisher= John Wiley & Sons|page= [https://archive.org/details/howtoreadpaperba00tgre/page/n20 1]|isbn=978-1-4443-9036-0}}</ref><ref name=sackett2 />

The two original definitions{{which|date=June 2017}} highlight important differences in how evidence-based medicine is applied to populations versus individuals. When designing guidelines applied to large groups of people in settings with relatively little opportunity for modification by individual physicians, evidence-based policymaking emphasizes that good evidence should exist to document a test's or treatment's effectiveness.<ref name="Eddy1990">{{cite journal | vauthors = Eddy DM | title = Practice policies: where do they come from? | journal = JAMA | volume = 263 | issue = 9 | pages = 1265, 1269, 1272 passim | date = March 1990 | pmid = 2304243 | doi = 10.1001/jama.263.9.1265 }}</ref> In the setting of individual decision-making, practitioners can be given greater latitude in how they interpret research and combine it with their clinical judgment.<ref name=sackett2 /><ref name="greenhalgh2">{{cite journal | vauthors = Tonelli MR | title = The limits of evidence-based medicine | journal = Respiratory Care | volume = 46 | issue = 12 | pages = 1435–1440 | date = December 2001 | pmid = 11728302 | author-link = Trisha Greenhalgh }}</ref> In 2005, Eddy offered an umbrella definition for the two branches of EBM: "Evidence-based medicine is a set of principles and methods intended to ensure that to the greatest extent possible, medical decisions, guidelines, and other types of policies are based on and consistent with good evidence of effectiveness and benefit."<ref name="eddybmapproach">{{cite journal | vauthors = Eddy DM | title = Evidence-based medicine: a unified approach | journal = Health Affairs | volume = 24 | issue = 1 | pages = 9–17 | date = 2005 | pmid = 15647211 | doi = 10.1377/hlthaff.24.1.9 | doi-access =  }}</ref>