Project to Enhance Research Literacy (PERL) - Achieving Competency in Evidence Informed Practice: A Resource Guide for Educators

EP1. Explain the role of scientific evidence in healthcare in the context of practitioner experience and patient preferences. 

Overview 

Healthcare providers make decisions regarding the clinical care of their patients. These decisions may be influenced by scientific data, clinical observations, longstanding tradition, a provider's experience, and/or the patient's request. Relying too heavily on any one of these factors will likely bias the decision and may result in sub-optimal care. Maximizing the likelihood of making the best decisions requires an equal balance of scientific evidence, clinician expertise, and patient preference. This approach was originally termed Evidence Based Medicine, and subsequent permutations have been called Evidence Based Practice (EBP) and Evidence Informed Practice (EIP, see #4 for a general definition). This competency focuses on understanding the integration of research evidence into clinical care.

Goal-Understand the integration of research evidence into clinical care. 

Learning Objectives

  • Describe the components of EIP.
  • Explain the rationale for applying EIP to clinical decision-making.
  • Illustrate the importance of EIP to integrative healthcare.

Resources

Sackett, D.L., Rosenberg, W.M., Grey, J.M., Haynes, R.B., Richardson, W.S. (1996). Evidence-based medicine, what it is and what it isn't. BMJ, 312(7023); 71-72. This definitive publication outlines the principle concepts of the evidence based medicine movement.

Shaughnessy, A.F., Slawson, D.C., Becker, L. (1998). Clinical jazz: harmonizing clinical experience and Evidence based medicine. J Fam Pract 47(6), 425-8. This now classic publication examines the interface between clinical expertise and research evidence.

Strauss, S.E., Glasziou, P., Richardson, W.S., Haynes, R.B. (2011). Evidence-Based Medicine: How to Practice and Teach EBM. 4th ed. Edinburgh: Churchill Livingstone. This book (for purchase) provides a comprehensive overview of evidence based medicine including teaching tips. The introduction defines evidence based medicine as well as a brief history of the EBM movement and some of its limitations.

What do we mean by "Evidence Informed Practice"? This document (provided courtesy of Northwestern Health Sciences University, 2013) provides a general definition for Evidence Informed Practice.

Introduction to Evidence Based Practice tutorial. This portion of the Essential EBP for Complementary and Alternative Medicine Study and Practice Guide (Barbara M. Sullivan, Ph.D. 2009, freely available through the National University of Health Sciences website) provides an overview and history of EIP.

Evidence Informed Practice Module- The first module in this series of freely available self paced on-line learning modules, developed by Northwestern Health Sciences University and the University of Minnesota, reviews the components of EIP and includes clinical case examples. If you decide to use this module in your course, please email Dr. Roni Evans (evans972@umn.edu) to track use and receive notification of the most up to date version.

Classroom Activity 

The Great Evidence Based Practice Debate This short video (provided courtesy of The University of Western States) is a fun approach to addressing disagreements often voiced during discussion of EIP. Challenges from various stakeholder viewpoints are included. One possible activity could include viewing the video during lecture then discussing the challenges to EIP with the class. Another activity might include assigning individual students to role-play these various stakeholders, using real world scenarios for their specific integrative health field, for a more interactive discussion on the interface of research evidence in clinical care. 

Vignette

Sara is a solo integrative practitioner working with patients in her private practice for over 20 years. She prides herself on providing compassionate care in a healing environment. Sara recently joined a local professional group for integrative providers in her community that meets regularly to discuss issues in their practices. At their last meeting, group discussion focused on new continuing educational requirements in evidence informed practice. Several in the group expressed concern that research evidence would supersede their clinical experience. Others felt that most research did not apply to the patients they see in their integrative settings. Sara explained how EIP is a process that incorporates clinical experience, one of the three pillars upon which EIP is based (the other two are best available research evidence and patient preferences). She also described a recent case study she found helpful to her practice, and highlighted how the process of EIP includes many different forms of research evidence.