From the Guidelines
The modern concept of Evidence-Based Medicine (EBM) is approximately 30-35 years old, having emerged in its current form in the early 1990s. The term "Evidence-Based Medicine" was formally introduced by researchers at McMaster University in Canada in 1992, as noted in a study published in the Journal of Clinical Oncology 1. This concept represented a paradigm shift in medical practice, moving away from reliance primarily on clinical experience and pathophysiological rationale toward the systematic evaluation and application of the best available research evidence.
While elements of evidence-based approaches existed earlier in medical history, the structured methodology of EBM—including systematic literature reviews, critical appraisal of evidence, and the development of clinical practice guidelines—became established during this period. A more recent study published in Clinical Microbiology Reviews in 2024 1 discusses the evolution of evidence-based practice (EBP) and its application in laboratory medicine, further highlighting the growth and adaptation of EBM principles over the years.
Key aspects of EBM include:
- The conscientious and judicious use of current best evidence derived from clinical care research in managing individual patients
- The use of systematic reviews (SR) to inform individual medical and scientific decisions with valid summary findings obtained through a systematic search of the available evidence
- The integration of a clinician’s expertise, proficiency, and judgment in making important medical decisions, diagnoses, and therapeutic choices based on the patient’s needs and evidence-based practice guidelines.
The establishment of the Cochrane Collaboration in 1993 further institutionalized the systematic review of medical evidence, contributing to the widespread adoption of EBM principles in clinical practice. Overall, the modern concept of EBM has been refined and expanded upon since its introduction in the early 1990s, with ongoing efforts to improve the quality and application of evidence-based medicine in real-world clinical settings.
From the Research
Age of the Modern Concept of Evidence-Based Medicine (EBM)
The modern concept of EBM is considered to have originated in the 1990s, with the term being formally defined by Sacket et al. in 1996 2. However, the history of EBM dates back to ancient times, with various eras of development, including the renaissance era, transitional era, and modern era 2.
Key Milestones in the Development of EBM
- The term "evidence-based medicine" was first used in the 1990s by investigators from McMaster's University 2.
- In 1996, Sacket et al. defined EBM as "the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients" 2.
- The modern era of EBM began in the 1970s, with the advent of technology, including computers and database software, allowing for the compilation of large amounts of data 2.
- The phrase "evidence-based medicine" was used for the first time in the medical literature less than 25 years ago, but the concept has become globally accepted in a short time 3.
Evolution of EBM Over Time
- EBM has evolved to incorporate clinical expertise and patient values and preferences into the decision-making process 3.
- There is a progressive move away from primary literature to systematic reviews and other "evidence-based summaries" 3.
- The future of EBM is likely to involve widespread utilization of "clinical (computer)-based decision support systems" 3.
- EBM has faced criticism and challenges, including the changing paradigm of healthcare, cost-effectiveness, and changing evidence 4.