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- Marc A. Raslich, MD*
- Gary M. Onady, MD, PhD*
- *Medicine-Pediatrics Program, Wright State University, Dayton, Ohio
Introduction
Teaching the incorporation of evidence-based medicine (EBM) into clinical decision-making is the major goal of this series. The first article defined and introduced the process of EBM. (1) The second two articles in the series introduced the first two steps and tools used in the EBM process, which are to develop an answerable question (2) and then to conduct an evidence-based search. (3) Before integrating this knowledge into clinical decision-making, the found information must be tested for validity. This third step in the EBM process is referred to commonly as critical appraisal. Critical appraisal forms the bridge between finding relevant data and applying the information to clinical practice.
How do we ensure that we have found the best answer to our clinical question? When using the medical literature to answer our questions, sometimes we can rely on others to do the background work for us. For example, a previous article in this series (3) refers to secondary sources, including synopses such as AAP Grand Rounds and syntheses such as the Cochrane Database. Secondary sources refer to publications that review research articles independently and appraise them for evidence. These resources can be useful but cannot be the sole source of information. Secondary resources do not always address specific clinical questions.
Therefore, the ability to evaluate the medical literature personally and judge its value independent of assessments made by others is essential. Critical appraisal provides the skill for evaluating the literature and reaffirming the quality of the originally structured answerable question. (4) This process enables physicians to recognize potential problems with the evidence, allowing use of the results in making an informed decision or deciding that the data are of insufficient quality to draw any useful conclusions. (5)
Thousands of studies are published each year. Given the sheer quantity of …
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