Critical appraisal skills should be considered a core competency for all physicians.  We would never expect that a physician not know something basic like anatomy or sterile technique because it takes time.  Basic critical appraisal skills should be a requirement

That was quite encouraging and actually raises an important issue. I have a feeling most physicians in the clinical world handling patients and management uncertainities don't have the time or know how to appraise evidence critically. Most view them as black boxes and generally tend to read and accept the conclusion of major trials or more helpfully metaanalysis as far as patient management is concerned. In such situations powerful evidence may become evidence which is presented by powerful people in powerful journals which most average physicians accept meekly.Each physician would however be engaged in his/her own personalised trial while treating patients on a daily basis and would be comparing his own results with that of the ones purported in powerful trials.This is all very well as far as therapeutic intervention is concerned but what about managing diagnostic uncertainities and unanswered questions that still remain even after successfully managing a given patient(remember all my boring/persistantly irritating clinical queries over the last few months)?

Since 1994 the NHS Centre
for Reviews and Dissemination has offered a free enquiry service which
is open to any health care professional in the UK

Thanks for the references. I wonder whether they would answer queries from physicians in other countries?

I feel EBM needs to be more individual patient centered.Very often  we dwell on a lot of interesting topics related to EBM but unless it helps us answer our clinical queries we may not be doing it justice.I haven't given up on this list and will continue to send my clinical queries( I have in fact recieved a few helpful suggestions to my clinical queries from list members who've mailed me personally, who don't mail the list as they are put off by those annoying out of office replies)

Another strange thing about EBM is that over the years even respectable EBM evolved from killer articles in powerful journals might turn dirty over a course of time(which varies among articles). A classical example would be the recent HRT-CAD flip.I wonder if theres a study on the amount of respectable EBMs which have turned dirty over the years and then we may subsequently have more on what are the predictors to studies likey to turn dirty. 

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