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Feature Article Evidence based practice; keep it simple stupid Dr. Jasan Dannaway MBBS (Hons I) B App Sci (Physiotherapy)
Jasan Dannaway is currently an intern at St Vincents Hospital (Sydney). At the time of writing this article he was a final year medical student at the University of Sydney.
Dr. Casey Maddren MBBS (Hons), FRACGP
Casey Maddren is a General Practitioner who works in an Aboriginal community south of Cairns. At the time of writing she was an academic registrar with the Department of General Practice, University of Sydney, Westmead Clinical School. She is currently a senior lecturer at James Cook University, Cairns.
Dr. Kumara Mendis MBBS, MSc, MD
Kumara Mendis was a Senior Lecturer of Rural Health at the School of Rural Health in Dubbo at the time of writing this article. He has been involved in teaching evidence-based medicine for some time and his subspeciality is medical informatics.
Learning and implementing evidence based practice is an expected component of good medical practice. Synthesising evidence in an effective and timely manner is a skill that is growing in importance and relevance. Evidence based practice is widely included in medical school curricula, and information literacy skills are known to be difficult to acquire. We provide a fresh look at a streamlined approach to evidence based practice, using a ‘real world’ case study.
Introduction The importance of evidence based practice (EBP) is ever increasing. [1,2] However, the complexities of collecting, interpreting and synthesising information may be time consuming and laborious. [3] Information literacy skills are known to be difficult to learn. [4] In an effort to condense the process, a variety of models have been designed for evidence retrieval, including the 4S, [5] the 5S, [6] and more recently the 6S pyramid (Fig. 1). [7] In this article we will focus on the 6S pyramid and its application to a clinical case.
The technology explosion of the last decade has increased access to information for clinicians in almost all settings. The rapid development of handheld electronic devices, paired with the licenses to evidence based databases being held by many universities and institutions,
• Computerised decision support systems
Systems • Evidence based clinical practice guidelines e.g. BMJ Clinical Evidence, Dynamed, Therapeutic Guidelines
Summaries
• Evidence based textbooks • Evidence based medicine reviews e.g. EBM Reviews - NHS Economic Evaluation Database, Health Technology Assessment, Cochrane Methodology Register, ACP Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials
Synopses of Syntheses
Syntheses
• Systematic reviews e.g. Cochrane library
Synopses of Studies
Studies
• Evidence based journals e.g. BMJ Evidence Based Medicine
• Original articles published in journals e.g. PubMed, EMBASE
Figure 1. The 6S Model. Modified from DiCenso et al (2009). [7]
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