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Peter Renshaw posted: > Yet another paper that assumes that evidence-based practice is all > about statistics and completely ignores that the well-described role > of clinical experience in the application of evidence-based medicine > (not to mention patient preferences). > > Have we failed to highlight clinical experience enough? IMHO, what is needed to better frame evidence-based practice isn't more emphasis on experience per se, but choice of a better theoretical framework. As an attractive alternative to "tacit knowing" one might look at the fourth knowledge dimension presented by Anderson, Krathwohl, et al. (A Taxonomy for Learning, Teaching and Assessing: A Revision of Bloom's Taxonomy of Educational Objectives, 2001, Addison Wesley Longman Inc.). Their taxonomy presents 6 cognitive dimensions on one axis, 4 knowledge dimensions on a second. Their 4 knowledge dimensions are factual knowledge, conceptual knowledge, procedural knowledge, and metacognitive knowledge. One could present EBM as being as sure as possible the conceptual knowledge (principles, theories, classifications, etc.) correctly explains interrelationships of factual elements and those facts are identified without significant bias (as by critical appraisal of biomedical literature), while also appreciating context & strategy (the cognition and awareness related to experience in practice). One element of their procedural knowledge is "knowledge of criteria for determining when to use appropriate procedures" which also could reflect EBM's concern about employing procedures most likely to produce an intended outcome. That approach would permit us to hang both quantitative & qualitative values within the matrix. Thus, it might be a better fitting framework for the comprehensive picture. David. -- David Birnbaum, PhD, MPH Adjunct Professor School of Nursing University of British Columbia Principal, Applied Epidemiology British Columbia, Canada