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OPTM 753

Optometry Clinic 3-3; Evidence-Based Practice

EBP Tutorial

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Evidence-Based Practice Cycle

Always Start and End with the Patient, applying the 5 A's of the Evidence-Based Practice Cycle

The Evidence-Based Practice Cycle follows the following steps:

  1. The patient dilemma - what needs to be treated / evaluated
  2. Ask - create a clinical question (PICO)
  3. Acquire - find the relevant evidence-based information
  4. Appraise - critically evaluate the acquired studies 
  5. Apply - use the best-evidence in clinical practice with patient
  6. Act - is this working for the patient? If not, repeat the process working to meet the needs of the individual patient

EBM Pyramid

The EBM Pyramid displays the hierarchy of levels of evidence based on the type of resource you are using. As you go up the EBM Pyramid, the level of evidence becomes stronger.  See the EBM Pyramid below.

Image of EBM Pyramid. From lowest level to top: Background Information / Expert Opinion, Case Controlled Studies / Case Series / Reports, Cohort Studies, Randomized Controlled Trials, Critically-Appraised Individual Articles [Article Synopses], Critically-Appraised Topics [Evidence Syntheses and Guidelines], and Systematic Reviews

Or see this guide which includes the EBP Pyramid as well as a list of resources to help you find information types for each level of the EBP Pyramid.

Getting Started with your EBP Query

Notice in the Evidence-Based Practice Cycle, after learning of your patient's health concern, the 2nd step is to Ask a clinical question. A standard format for the clinical question is PICO. See the next guide page to learn about PICO.