Dear All
The recent debate over the relative values in the hierarchy of research
evidence has been excellent. It would appear that (as with most evidence
based issues) the definition of a clear bottom line message about the
hierarchy of research evidence is both complex and difficult.
This debate has prompted me to ask the list about a problem that I have
often considered with the evidence based practice model. If Sackett et al's
definition of evidence based medicine is acceptable ( essentially evidence
based medicine involves the use of quality, up-to-date reliable research
evidence INTEGRATED with clinical judgement and expertise)then there would
appear to be a relative imbalance in our approach to using evidence based
medicine. This is because although much debate occurs over the 'quality' of
research evidence, little attention is given to the value of clinical
judgement. Surely even the highest level of research evidence needs clinical
judgment (of equal value?) to assist in the implementation of that evidence?
Is this not also one of the multi-factoral reasons why research evidence is
so difficult to get into clinical practice?
Apart from the existing obvious 'measurements' of clinical performance
(post-graduate qualification etc.) which I presume have not been thoroughly
investigated in the context of evidence based practice is anyone aware of
research in this area?
Thoughts and opinions would also be welcome....
Alistair Grant
Cambridge UK
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