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ur – More diasgnostic tools, more drugs, more treatment methods – “Half of what you are taught as medical students will in 10 years have been shown to be wrong. And the trouble is, non of your teachers knows which half.” ? Increasing medical costs ? The patient knows more, and questions more! Background ? Too little time – To keep up to date in Internal Medicine, I need to read 17 articles a day, 365 days a year Background ? False evidence ? Anesthesia and Analgesia – 2022 IF – 2022 Total Cites 15960 Definition ? Evidence Based Medicine – is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. – Sackett, D. L. BMJ 1996 – Evidencebased medicine is the integration of best research evidence with clinical expertise and patient values – Sackett, D. L. 2022 Definition ? EBM: A Practical Definition – When there is evidence of benefit and value, do it. – When there is evidence of no benefit, harm or poor value, don’t do it. – When there is insufficient evidence to know for sure, be conservative. – And whatever we do, do it right! – David Eddy Definition Clinical expertise 臨床技能 外部證據(jù) External evidences Patient Values and Preferences 病人價(jià)值 Clinicians ? Individual clinical expertise – the increasing proficiency and judgement that individual clinicians acquire through clinical experience and clinical practice. Clinicians ? EBM is a Lifelong learning model – lifelong, selfdirected, problembased learning – EBM propose methods to find and evaluate evidence. – EBM converts the abstract exercise of reading and appraising the literature into the pragmatic process of using the literature to benefit individual patients while simultaneously expanding the clinician’s knowl