Evidence-Based Medicine

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EBM Pyramid


Sackett DL, Richardson WS, Rosenberg W, Haynes RB (1997). Evidence-based medicine: How to practice and teach EBM. New York: Churchill Livingston.


The EBM process is contained in 4 steps:

  1. Ask
  2. Acquire
  3. Apraise
  4. Practice

This process is further clarified and defined by the PICO process:


What are the important characteristics of this patient?

  • Primary Problem
  • Patient's main concern or chief complaint
  • Disease or health status
  • Age, Race, Sex, Previous ailments, current medications


It is important to identify what you plan to do for that patient. This may include the use of a specific diagnostic test, treatment, adjunctive therapy, medication or the recommendation to the patient to use a product or procedure. The intervention is the main consideration for that patient or client.


What  is the main alternative you are considering? The Comparison is the only optional component in the PICO question. One may only look at the Intervention without exploring alternatives, and in some cases, there may not be an alternative


This specifies the result(s) of what you plan to accomplish, improve or affect and should be measurable. Outcomes may consist of:

  1. Relieving or eliminating specific symptoms
  2. Improving or maintaining function
  3. Enhancing esthetics.