EVIDENCE BASED PRACTICE

DR.MUHAMMAD RIZWAN
SHS UMT LAHORE
 OBJECTIVES

By the end of this session, you shall be able to:

1. Clarify some Misconceptions about EBP.

2. Identify Different Types Of Practitioners.

3. Consider What Is Reflective Practice.

4. Differentiate between Traditional and Problem based

learning.
 MISCONCEPTIONS ABOUT EBP

1. It ignores Clinical Expertise.

2. It ignores Patient Values & Preferences.
3. It is a Cookbook Approach.
4. It is simply a Cost-cutting Tool.
5. It is limited to Clinical Research.
6. IT CANNOT BE DONE 
 1. It Ignores Clinical Expertise
Counterargument

 Clinical expertise is key in EBP for maximized

outcomes along with;
• External research findings
• Client characteristics
• Circumstances
• Client preferences
 2. It Ignores Patient Values and
Preferences

Counterargument.

• Attention is paid to Patient’s values and

expectations.

• Patients participates in decision making.

 3. It Is a Cookbook Approach

Counterargument.

• Consideration of Client Values & Expectations as

well as the Extent To Which Research Findings Apply
to a Particular Client shows that it is not a cookbook
approach.
 4. It Is Simply a Cost-Cutting Tool
Counterargument.

• Straus and McAlister (2000) and Sackett et al. (1997)

noted that EBP may increase, not decrease, the cost.
 5. It Is Limited To Clinical Research
Counterargument.

• Research is not always carried out on patients.

• It may include in-depth interviews with caregivers.

 5. It Is Limited To Clinical Research

• The settings may not always be a clinical one and

may include

– patient’s home

– other community environments,

– community based health promotion programs.

 6. IT CANNOT BE DONE.

Counterargument.

• Audits and surveys of clinicians suggest that EBP can

be practiced clinically.

(Ellis, Mulligan, Rowe & Sackett 1995)

• In spite of real challenges to implementing EBP,

professionals should address these challenges.
DIFFERENT TYPES OF PRACTIONERS
 STUDENT LIFE
(Pre-service Experience)

• Students learn the knowledge base of the discipline

and are exposed to the available Evidence for current
treatment.

• They learn how to use the available Evidence and

knowledge.

• They usually follow what they learn and do not ask

questions to challenge their beliefs.
 Student’s Information Needs

• Sources of Answers
– Textbooks (31%)
– Articles (21%)
– Consultants (17%)

• Most of their Questions are NEVER answered 

• When answered, the information is likely to be

neither the best nor up-to-date 
 Novice Practitioners
• ‘Novice Practitioners need rules to help them organize
their thoughts, observations, and actions’.(Bnner,1984)

• They focus on Objective Findings.

• Complexities of Doctor-Patient Relationship,

Environment and Understanding of Patient’s
Expectations are beyond their capacity.
 Experienced Practitioner
• During this period Professionals attain most of the
Required Information for Practice.
• Create their Own Personal Database.
• Establish methods for evaluating the Effectiveness Of
Selected Interventions based on their personal
Database.
• Share their Personal Database with other Professionals,
Friends and Colleagues.
 Expert Practitioners

• Expert Practitioners maintain these rules but shift

them to the Background.

• Have the capability to handle new situations by

using their Professional Experience.

• Understand the individual patient situation and can

Create, Tailored Environment too, based on their
Knowledge & Experience.
THE REFLECTIVE PRACTIONER
 A Question to ask from yourself as a
Practitioner
• Have you ever managed to find Time And Motivation,
to write down your Information Needs, as they arise in
a way, that may lead you to a Clinically Useful
Conclusion ???

YES… or… NO…

If NO, then you may be missing some opportunities to
improve your clinical knowledge and performance.

If YES, then you are showing REFLECTION.

 Reflective Practitioner

“Practitioner is a Person who Practices a specific

Profession or Occupation”

Whereas

“Reflection is an Active Process Of Witnessing One’s

Own Experience in order to take a closer look at it”
 Reflection and Reflective Practitioner

• Reflection; is a meta-cognitive process in which we

think about our thinking.

• Reflective Practitioners think critically, modify their

actions, behaviors or learning needs.

• “The opportunity to Re-think about Practices

becomes a tool for Professional Learning and
contributes to an individual’s Practice-knowledge
and Clinical Expertise” (Gamble et al
2001)
 Reflection as Learning Tool
• As MEDICAL PROFESSIONALS, we should know the
reasons underlying our actions.

• We should use reflection in our actions.

• In routine practice, Experienced medical professionals

do not pay any attention, unless they face a new
challenge.

“Reflection represents the art of practice and knowledge

and evidence the science of practice”
(Schon 1987)
Reasons for being Reflective Practitioner

• To enable professional development and maintain

quality

• Reflecting on what went wrong and why

=improvement

• Reflecting on what went well and why = good

practice

• Plan to improve skills if necessary, or to use those skills

in future events
 Benefits Of Being A Reflective
Practitioners?

• The best practitioners are constantly learning,

evaluating and refining their practice, even after years
of experience.

• The next stage is to apply what you have learned from

one situation to the next
 CONTRAST
Traditional Teaching Problem-Based Learning
Method
 Teaches how to pose
vital, specific,
• Teaches knowledge as a answerable questions
collection of facts and
skills  Shows students how to
find articles and
• Gives students readings evidence specific to
from texts and articles their questions

• Mixes evidence
indiscriminately to
support a particular
position
 CONTRAST
 Provides students with
• Rewards students for a template for
the right answer determining a
hierarchy of evidence
 Rewards students for
• Teacher lectures and the process of problem
demonstrates to solving
students  Teacher serves as a
coach to small groups
Thank you for joining in 

Questions
or comments?