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      Sicily statement on evidence-based practice


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          A variety of definitions of evidence-based practice (EBP) exist. However, definitions are in themselves insufficient to explain the underlying processes of EBP and to differentiate between an evidence-based process and evidence-based outcome. There is a need for a clear statement of what Evidence-Based Practice (EBP) means, a description of the skills required to practise in an evidence-based manner and a curriculum that outlines the minimum requirements for training health professionals in EBP. This consensus statement is based on current literature and incorporating the experience of delegates attending the 2003 Conference of Evidence-Based Health Care Teachers and Developers ("Signposting the future of EBHC").


          Evidence-Based Practice has evolved in both scope and definition. Evidence-Based Practice (EBP) requires that decisions about health care are based on the best available, current, valid and relevant evidence. These decisions should be made by those receiving care, informed by the tacit and explicit knowledge of those providing care, within the context of available resources.

          Health care professionals must be able to gain, assess, apply and integrate new knowledge and have the ability to adapt to changing circumstances throughout their professional life. Curricula to deliver these aptitudes need to be grounded in the five-step model of EBP, and informed by ongoing research. Core assessment tools for each of the steps should continue to be developed, validated, and made freely available.


          All health care professionals need to understand the principles of EBP, recognise EBP in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills, professionals and organisations will find it difficult to provide 'best practice'.

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          Most cited references59

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          Evidence-Based Medicine

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            Validation of the Fresno test of competence in evidence based medicine.

            To describe the development and validation of a test of knowledge and skills in evidence based medicine. Cross sectional study. Family practice residency programme in California; a list server for those who teach evidence based medicine; and an evidence based medicine seminar series. Family practice residents and faculty members (n=43); volunteers self identified as experts in evidence based medicine (n=53); family practice teachers (19) beginning a seminar series on evidence based medicine. The Fresno test is a performance based measure for use in medical education that assesses a wide range of evidence based medicine skills. Open ended questions are scored with standardised grading rubrics. Calculation skills are assessed by fill in the blank questions. Inter-rater reliability, internal reliability, item analyses, and construct validity. Inter-rater correlations ranged from 0.76 to 0.98 for individual items. Cronbach's alpha was 0.88. Item difficulties ranged from moderate to difficult, all with positive and strong ability to discriminate between candidates. Experts scored consistently higher than novices. On the 212 point test, the novice mean was 95.6 and the expert mean was 147.5 (P<0.001). On individual items, a higher proportion of experts than novices earned passing scores on 15 of the 17 items. The Fresno test is a reliable and valid test for detecting the effect of instruction in evidence based medicine. Its use in other settings requires further exploration.
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              The well-built clinical question: a key to evidence-based decisions.


                Author and article information

                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                5 January 2005
                : 5
                : 1
                [1 ]Department of Family Medicine. McGill University, Montreal, Canada
                [2 ]The Lancet, Jamestown Road, London, UK
                [3 ]Department of Primary Health Care, Centre for Evidence-Based Practice, Oxford University, Oxford, UK
                [4 ]Gruppo Italiano per la Medicina Basata sulle Evidenze (GIMBE), Passaggio L. da Vinci, 16 – 90145 Palermo, Italy
                [5 ]London Health Sciences Centre, Department of Physiology & Pharmacology, University of Western Ontario, London, Ontario, Canada
                [6 ]School of Medicine, Health Policy and Practice, University of East Anglia Norwich, UK
                [7 ]University Hospital Ulm, Clinical Economics, Ulm, Germany
                [8 ]Department Public Health and Epidemiology, University of Birmingham, Birmingham UK
                [9 ]United Bristol Healthcare Trust, Bristol, UK
                Copyright © 2005 Dawes et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 3 October 2004
                : 5 January 2005



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