■JAMA CLASSICS CELEBRATING 125 YEARS Progress in Evidence-Based Medicine SUMMARY OF THE ORIGINAL ARTICLE 8 a Evidence-Based Medicine Working Grou MA1992-268/172420-2425. wjama.com for full text of the ake by( ral medicine),student ly popular and is ly used in The mu e in tanding information,the dev oment of preproces sed evi red traditio The article new appre The development of the has made finding and The Rapid Develo and Uptake of EBM agno n Group.De of readers understand the value of t.MD.M 814A015.200 C2008 Ame Downloaded from www.iama.com by quest on August 17.2010 第4页JAMA CLASSICS CELEBRATING 125 YEARS Progress in Evidence-Based Medicine SUMMARY OF THE ORIGINAL ARTICLE Evidence-Based Medicine: A New Approach to Teaching the Practice of Medicine Evidence-Based Medicine Working Group JAMA. 1992;268(17):2420-2425. A new paradigm for medical practice is emerging. Evidence￾based medicine de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making and stresses the examination of evidence from clinical research. Evidence￾based medicine requires new skills of the physician, including efficient literature searching and the application of formal rules of evidence evaluating the clinical literature. See www.jama.com for full text of the original JAMA article. Commentary by Victor M. Montori, MD, MSc, and Gordon H. Guyatt, MD, MSc I N 1992 JAMA PUBLISHED AN ARTICLE BY THE EVIDENCE￾Based Medicine Working Group focusing on the role of evidence-based medicine (EBM) in medical educa￾tion.1 Although the term evidence-based medicine first appeared in the published literature the prior year,2 the JAMA publication brought both the label and the underlying phi￾losophy to the attention of a wider medical community. The article was audacious in suggesting that EBM repre￾sented a new paradigm in the teaching and practice of medi￾cine by deemphasizing unsystematic clinical observations, pathophysiological inference, and authority. The article hon￾ored traditional skills (eg, understanding biology, demon￾strating empathy), but emphasized new skills thatlearnersmust acquire and use: question formulation, search and retrieval of the best available evidence, and critical appraisal of the study methods to ascertain the validity of results. The article ag￾gressively presented EBM as a fundamentally new approach. The Rapid Development and Uptake of EBM The Users’ Guides to the Medical Literature series in JAMA3 that quickly followed the article1 provided tools for learn￾ers and teachers to hone their skills in appraising and ap￾plying results of studies focused on questions of therapy, diagnosis, prognosis, and harm. Subsequent articles in this series, which eventually addressed 25 separate topics, helped readers understand the value of systematic reviews, deci￾sion and economic analyses, and practice guidelines. Courses on how to teach EBM, popular books on the subject (in￾cluding one based on the Users’ Guides series4 ); related se￾ries in medical and surgical specialties; and enthusiastic up￾take by junior faculty (mostly in general medicine), students, and trainees followed. The term EBM proved extraordinar￾ily popular and is now widely used in related health fields (eg, evidence-based health policy, evidence-based nurs￾ing). The influence of EBM has been widely recognized both in lay publications (eg, the New York Times listed EBM as one of its ideas of the year in 2001) and in the academic press (eg, BMJ listed EBM as one of the 15 greatest medical mile￾stones since 1840). Key developments since the recognition of EBM have in￾cluded enormous advances in ease of accessing and under￾standing information, the development of preprocessed evi￾dence-based information, and the increasing emphasis on patients’ values and preferences in clinical decision making. Evolution of EBM: Knowledge Access and Dissemination The development of the Internet has made finding and re￾trieving original articles much easier. Emblematic of this ef￾fort is the pioneering work of the National Library of Medi￾cine in developing and maintaining the MEDLINE database. Users often access this database from its own interface, Author Affiliations: Knowledge and Encounter Research Unit, Department of Medi￾cine and Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minnesota (Dr Montori); and Clinical Advances Through Research and Information Translation (CLARITY) Research Group, Department of Clinical Epi￾demiology and Biostatistics, and Department of Medicine, Faculty of Health Sci￾ences, McMaster University, Hamilton, Ontario, Canada (Dr Guyatt). Corresponding Author: Gordon H. Guyatt, MD, MSc, Department of Clinical Epi￾demiology and Biostatistics, Health Sciences Centre, Room 2C12, McMaster Uni￾versity, Hamilton, ON, Canada L8N 3Z5 (guyatt@mcmaster.ca). 1814 JAMA, October 15, 2008—Vol 300, No. 15 (Reprinted) ©2008 American Medical Association. All rights reserved. Downloaded from www.jama.com by guest on August 17, 2010 第 4 页